We report a case of epithelial ingrowth through a buttonhole 6 months after laser in situ keratomileusis. Elevation topography showed irregular astigmatism and an unreliable pachymetric map. In vivo confocal microscopy showed an epithelial basal cell mosaic with prominent borders and distinct nuclei. No corneal nerves were identified in any image. Cells in the anterior stroma possessed bright, reflective nuclei and appeared to form clusters. The interface between the stromal bed and the flap had formation of nests of fibrotic tissue and epithelial cells.