Purpose : To report a patient with Urrets-Zavalia (U-Z) syndrome after penetrating keratoplasty (PKP) in both eyes

Case report : A 22-year-old woman with keratoconus associated with a central full thickness scar in both eyes underwent PKP in her right eye that was postoperatively associated with a fixed dilated pupil and severe fibrin reaction, posterior synechiae and mild anterior sub capsular cataract. However he developed fixed dilated pupil leading to posterior synechiae after PKP in the second eye.

Conclusion : This case shows an intrinsic susceptibility for U-Z syndrome which alerts surgeons in the case of second eye surgery.