A 59-year-old woman presented with bilateral corneal crystals (Figure, A). Ocular cystinosis was suspected; however, there were no pathogenic variants in the cystinosin, lysosomal cystine transporter (CTNS) gene. No underlying causative mechanism raising concern for systemic disease was revealed by a kidney biopsy. A positive M spike led to a bone marrow biopsy, which showed 20% plasma cell neoplasm and confirmed a diagnosis of multiple myeloma. A corneal biopsy was performed prior to further organ system evaluation, and immunohistochemical staining returned positive results for κ light chains (Figure, B). No other organ systems were involved. The positive corneal biopsy results confirmed the end-organ involvement criteria to qualify for a bone marrow transplant. This case demonstrates ocular involvement being the determining factor to proceed with a bone marrow transplant for a patient with multiple myeloma and shows how bilateral corneal crystalline deposits should prompt immediate investigation for systemic disease.