A 20-year-old woman developed unilateral fungal keratitis after small-incision lenticule extraction (SMILE). The clinical presentation and subsequent management of the case is presented. The management of infectious keratitis after small-incision lenticule extraction could be challenging because performing an adequate scraping is difficult and topical medication penetration is limited in deep-seated infiltrates. An interface wash afforded deeper penetration of antifungal agents, resulting in gradual clinical improvement. A high degree of clinical suspicion for fungal etiology is necessary even with early onset of presentation, and corticosteroid administration should be withdrawn until confirmed microbiological diagnosis. In addition, an interface wash during small-incision lenticule extraction could serve as a source of direct microbiological inoculation into the stroma and might be avoided. Prompt scraping for microbiological analysis and subsequent interface irrigation helped limit disease severity and significant visual loss. To our knowledge, this is the first reported case of fungal keratitis after small-incision lenticule extraction.
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