An 83-year-old female presented with progressive bilateral lipid keratopathy (LK) during the last 12 years. There was no history of previous ocular disease or trauma. Slit lamp examination of the left eye revealed a diffuse LK obscuring the visual axis and a temporal epithelial papillomatous lesion with superficial neovascularization (Figure A), while Best Corrected Visual Acuity (BCVA) was 20/200 with eccentric fixation. An uneventful Penetrating Keratoplasty (PKP) combined with excision of the temporal lesion was performed.