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Abstract Background This is a case of spontaneous toric implantable collamer lens (TICL) rotation that occurred twice in the left eye of a patient. Case presentation A 24-year-old gentleman received TICL implantation for treatment of myopic astigmatism encountered with spontaneous rotation of approximately 90° from its original position. TICL reposition procedure was performed with visual outcome of 20/16. Surprisingly, a re-rotation of TICL occurred. The patient underwent a replacement of non-toric ICL with a larger size after careful re-evaluation with final visual outcome of 20/20. A short and small ciliary process with shallow ciliary sulcus and posteriorly positioned ciliary body was found by Ultrasound Biomicroscopy (UBM). Conclusions The unique morphology of the ciliary body may have a potential association with the vault and instability of implanted ICL. Careful examination of the ciliary body morphology is essential in preoperative evaluation.