A 61 year old female with no prior ocular history developed progressive anterior chamber shallowing following uncomplicated phacoemulsification and intraocular lens implantation. This shallowing rapidly accelerated after Nd:YAG laser capsulotomy, and led to a significant myopic shift. Ultrasound biomicroscopy imaging demonstrated anterior displacement of the irido-lenticular diaphragm and anterior rotation of ciliary processes confirming a diagnosis of aqueous misdirection. One year after Nd:YAG anterior hyaloidotomy and medical therapy, her anterior chamber deepened and myopic shift resolved. This case demonstrates the successful management of chronic pseudophakic aqueous misdirection without the need for surgical intervention.