A 22-year-old female patient presented with pain and reduced vision in her right eye for the past few days. She had a three-year history of monthly soft contact lens wear and a past medical history of anxiety managed with citalopram. She was otherwise well. The patient worked as a veterinary student, reported to showering in her contact lenses and denied a history of trauma. On presentation right CDVA was 20/120 with spectacles (pinhole 20/30) and 20/16 on the left. The conjunctiva was injected on the right. In the mid peripheral cornea there was a 4 mm by 4 mm epithelial defect within which there was a dense infiltrate measuring 2.2 mm by 1.7 mm. The anterior chamber was quiet. A diagnosis of microbial contact lens related keratitis was made.

A corneal scrape was performed, and levofloxacin 0.3% drops were started hourly day and night. On review day three, right CDVA had improved to 20/80 (pinhole 20/30) and the eye felt more comfortable. However, the infiltrate and epithelial defect had increased in size. Cefuroxime 5% drops were added hourly day and night. On review day 5, the visual acuity had improved to 20/40 on the right with glasses (pinhole 20/30). The right eye remained intermittently sore. On examination, the epithelial defect had increased in size to 8 mm by 8 mm, with the mid peripheral infiltrate now chalky in appearance measuring 2.5 mm by 2.5 mm. Satellite lesions were also apparent. A clinical diagnosis of fungal keratitis was made, which was confirmed by a positive culture of scanty growth of fungus from the initial corneal scrape.

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