Herein a case of acute corneal hydrops with perforation in keratectasia 9 years after bilateral laser in situ keratomileusis is presented. A 27-year-old man presented with right eye sudden loss of vision. Right eye best-corrected visual acuity was counting fingers. Left eye best-corrected visual acuity was 6/9. Right eye slit-lamp examination revealed diffuse corneal oedema with central epithelial cystic change. The interface between the flap and residual stroma was open and filled with fluid. This separation extended nearly to the flap margin. Shallow anterior chamber and aqueous leakage were noted the following day. An emergency penetrating keratoplasty was performed to the right eye. Histopathology of corneal button revealed reactive keratocytes with irregular, wrinkled collagen formation over ablated stroma. Marked stromal oedema was observed. Twelve months after corneal transplantation, vision improved to 6/6 with correction in the right eye.