We describe a case of necrotizing keratitis that developed after laser in situ keratomileusis (LASIK) in a 50-year-old woman with inflammatory bowel disease. The patient had not disclosed her history of a total colectomy for recurrent ulcerative colitis and developed bilateral stromal inflammation and corneal melting along the flap edge with ulceration within 3 days of uneventful bilateral LASIK for myopia. She was aggressively managed with topical and systemic corticosteroid therapy. Flap infiltrates gradually resolved, with no relapse during the 12-month follow-up. This case highlights the importance of taking a detailed history, specifically addressing autoimmune diseases, before corneal refractive surgery.