To describe a case of very asymmetric ectasia successfully treated by femtosecond laser-assisted intracorneal ring segment implantation, in which the diagnosis of unilateral ectasia in the right eye was based on the clinical findings including history, follow-up, and advanced diagnostic data. The patient's history was positive for ocular allergy with moderateto-intense eye rubbing only in the right eye. The uncorrected distance visual acuity was 20/63 in the right eye and 20/32 in the left eye. The corrected distance visual acuity (CDVA) was 20/40 in the right eye (−1.75−4.00 × 35°) and 20/16 in the left eye (−0.50−0.25 × 115°). After femtosecond laser-assisted intracorneal ring segment implantation, the right eye improved CDVA to 20/20 −1 . Concerning ectasia/keratoconus diagnosis, the left eye remained stable over 1 year of follow-up with unremarkable topometric, tomographic, and biomechanical findings. Epithelial thickness mapping by spectral domain optical coherence tomography and very-high-frequency digital ultrasound demonstrated epithelial thickness within normal limits in the left eye. Advanced diagnostic methods along with clinical data enable the distinction from unilateral ectasia cases and subclinical (fruste) keratoconus. Literature review is also performed along with case presentation and discussion.