We report a 10-year-old boy with unusually dense, bilateral central posterior capsule pigmentation associated with the characteristic clinical features of pigment dispersion syndrome, including Krukenberg’s spindle and dense trabecular pigmentation in both eyes. There was no history of trauma , laser or intraocular surgeries . The presence of posterior or backward bowing of iris suggested a reverse pupillary block mechanism of pigment dispersion syndrome. Nd Yag laser peripheral iridotomy was performed in both eyes to relieve reverse pupillary block. Anterior segment optical coherence tomography (AS-OCT) showed reversal of iris concavity after laser iridotomy.