- To report a case with bilateral progressive lipid keratopathy. A 44-year-old healthy man without previous ocular disease presented with bilateral lipid keratopathy which was more severe in his right eye. Evidence of hyperlipidemia or clinical corneal neovascularization was not apparent. Penetrating keratoplasty (PKP) was performed, initially in the right eye and four years later in the left eye. Histochemical examination showed focal stromal vascularization and staining for lipids. During the follow-up period, one episode of graft rejection occurred in each eye; both responded to systemic steroid therapy. Severe bilateral progressive lipid degeneration can develop in previously healthy corneas in healthy patients without underlying pathology. The nature of the process remains unclear. When PKP is performed and neovascularization is identified in the removed corneal button, close follow-up is advisable because corneal grafts can be prone to rejection.