Anterior segment dysgenesis is characterized by a spectrum of congenital anomalies involving the cornea, the iris, and the anterior chamber angle; it may be further complicated by systemic anomalies and glaucoma. Peters' anomaly, a specific type of mesenchymal anterior segment dysgenesis, is characterized by a central corneal leukoma, iridocorneal adhesions, and abnormalities of the posterior corneal stroma, Descemet's membrane, corneal endothelium, lens, and anterior chamber. Eighty percent of the cases are bilateral. We present an unusual unilateral case of Peters' anomaly complicated by postsurgical ocular muscle deviation, an iatrogenic corneal tattoo, cataract, and papillary conjunctivitis associated with contact lens wear. This article illustrates the classification of variants of anterior segment dysgenesis and the technique of corneal tatooing, as well as the use of prosthetic contact lenses in the management of corneal opacities. We stress that successful management of Peters' anomaly requires proper diagnosis of the condition, age-appropriate treatment with surgical consultation, and careful follow-up in affected patients.