Purpose. To report confocal microscopy findings of a patient With multiple myeloma crystalline keratopathy and the response to treatment. Methods. Confocal microscopy images of the cornea were taken OU and the corneal crystals analyzed using the Cell Counter software. Results. Numerous hyperreflective globules 6-11 nm in size were located within the corneal epithelium and anterior stroma, These crystals obscured normal architectural detail of the cornea. After 6 months of chemotherapy, confocal microscopy was repeated and demonstrated decrease in the size and number of hyperreflective globules. Conclusion. Confocal microscopy can enable the clinician to monitor the clinical response of multiple myeloma crystalline keratopathy to chemotherapeutic agents.