Intestinal parasitic infection is an important healthcare system in developing countries including Iran. In the present study salt and pepper retinal changes were diagnosed in 4(5.3%) patients with giardiasis among them one patient was cured after anti-parasitic medication.Several studies have discussed the association between parasitic infection especially G.lamblia and ocular involvements[7].The first report of iridocyclitis, choroiditis, and retinal hemorrhages in patients with symptoms like diarrhea linked to the presence of G.lamblia was described by Barraquer in 1938[9]. More recent observations described a “salt and pepper” degeneration (punctuate areas of normal hyperpigmentation on a light yellow pink-retina) involving the retinal pigmented epithelium in patients suffering from giardiasis[10].The same complication was described in cases with past giardiasis, indicating that the ocular changes observed did not require the concurrent presence of the parasite in the gut. Notably small children are more susceptible to ocular lesions during giardiasis. Corsi et al in 1998 carried ophthalmic examination of 141 students with active or passive giardiasis with a mean age of 4.7±2 years old and diagnosed the salt and pepper lesions in 28 (19.9%) of them[7].Our results showed that of 4 (5.3%) subjects with salt and pepper lesions, 2 were students and that sounds the same as the findings achieved by Corsi et al.The mechanisms by which the giardia parasite causes ocular lesions are currently obscure, but they exclude the possibility of direct invasion by the parasite despite defects in documents on microscopic examination of ocular tissues[11]. It seems that retinal salt and pepper lesions are caused by damage or necrosis of the cells of the retinal pigment epithelium with the release of pigment granules that migrate to the deeper retinal layers where they appear as black dots. These findings are not specific to giardiasis, in other diseases such as cystinosis, various types of infection including congenital rubella, syphilis, toxoplasmosis, and onchocerciasis the same signs have been reported. We did not find salt and pepper lesions in cases with other intestinal parasitic infections besides G.lamblia, but in our previous study in Mazandaran province 5 (41.6%) of cases infected with Blastocystis hominis and 1(8.3%) case was infected with Entamoeba coli[6]. An important point is that for many years, Entamoeba coli and Blastocystis hominis were considered non-pathogen protozoan, but new research has demonstrated their harmful effects on human health [12, 13]. Although some parasites can cause retinopathy, this complication may be misdiagnosed as a side effect of medicines like hydroxychloroquine.Drugs such as hydroxychloroquine and chloroquine can damage vision because of their toxic effects, due to slow accumulation of the drugs in the retinal epithelium that results in irreversible visual loss. It may occur during the prophylactic or therapeutic attempts in cases like malaria disease or other medicines such as phenothiazine, iodinated substances, and oral contraceptives[1,7]. Many doubts and contradictions have taken place in the type and frequency of ocular examination in patients taking these drugs. Parasitic infections may involve either the anterior or posterior segment of the eye and lead to various ophthalmic manifestations. Involvement of posterior segment includes choroiditis, retinichoroiditis, retinal vasculitis, retinal hemorrhage, central retinal vein thrombosis, papilledema, retinal detachment, orbital cysts, and optic atrophy that lead to permanent retinal damage and visual loss.T.gondii can be considered the first infectious cause of posterior uveitis worldwide, being responsible for 30% to 50% of all posterior uveitis in immunocompetent subjects[14]. T.gondii reaches the eye via retinal rather than choroidal circulation and then migrates within the retina[15]. Although most of the ocular presentations of toxoplasmosis were attributed to congenital toxoplasmosis and have been neglected as a serious health concernunfortunately, new studies declared that most of the cases are due to after-birth infection[14]. Considering the vast distribution of the parasite with approximate infection of one-third of the world population, it is not fustian to consider T.gondii as the most important agent of parasitic ocular involvements.In Iran, the most prevalent protozoan parasites were T.gondiiwitha prevalence of 39.3% in 2013, G.lamblia with a prevalence of10.6% followed by Cryptosporidium spp with 2%, and E. histolytica/dispar with 1.3 in 2021 based on a meta-analysis. These studies revealed that T.gondiiand G.lamblia are the most prevalent parasites in Iran and considering the point of their ability to cause ocular damage, more controlling strategies are needed to reduce the burden of protozoan parasitic infections.In some cases, retinopathy is irreversible and leads to loss of partial or complete vision which would be cured with only a simple ant-parasitic medication if diagnosed in time.Despite the important sight-threatening effects of parasites, not enough studies are available in this regard. In Iran, in one study carried out by Dalimi et al in Tehran in 2004, in 50 patients with giardiasis, six cases had salt and pepper lesions and in three cases the lesions disappeared after anti-parasite treatment with Metronidazole[16]. Another study conducted in Iran by Jafari et al in 2020 in Mazandaran province revealed that in 75 subjects with at least one intestinal parasitic infection, 12(16%) of cases showed salt and pepper retinal changes[6]. No more studies are available about retinal changes in cases infected with intestinal parasites in Iran.