Purpose To find objective characteristics of superficial punctate keratopathy (SPK) in toxic keratopathy(TK) compared with dry eye(DE) in assistance of in vivo laser scanning confocal microscopy (LSCM), in hope of facilitating the early diagnosis of TK.Methods Nine patients with TK and 11 patients with DE, demonstrating SPK under slit-lamp observation, were enrolled in the study.All underwent history interview, fluorescein staining, tear film break-up time (BUT) test and Schirmertest.LSCM was applied to quantitatively examine the densities of the superficial and basal epithelial cells, subbasal nerve plexus, Langerhans cells and stromal keratocytes, and nonquantitative abnormalities of the epithelia and stroma were also described and compared.