The Mycotic Ulcer Treatment Trial II: A Randomized Trial Comparing Oral Voriconazole vs Placebo

Inclusion Criteria: * Presence of a corneal ulcer at presentation * Evidence of filamentous fungus on smear (KOH wet mount, Giemsa, or Gram stain) * Visual acuity worse than 6/120 (20/400, logMAR 1.3) * The patient must be able to verbalize a basic understanding of the study after it is explained to the patient, as determined by physician examiner. This understanding must include a commitment to return for follow-up visits. * Willingness to be treated as an inpatient or to be treated as an outpatient and return every 3 days +/- 1 day until re-epithelialization and every week to receive fresh medication for 3 weeks * Appropriate consent Exclusion Criteria: * Evidence of bacteria on Gram stain at the time of enrollment * Evidence of acanthamoeba by stain * Evidence of herpetic keratitis by history or exam * Corneal scar not easily distinguishable from current ulcer * Age less than 16 years (before 16th birthday) * Bilateral ulcers * Previous penetrating keratoplasty in the affected eye * Pregnancy (by history or urine test) or breast feeding (by history) * Known liver disease, including hepatitis or cirrhosis (Child-Pugh A-C) * Acuity worse than 6/60 (2/200) in the fellow eye (note that any acuity, uncorrected, corrected, pinhole, or BSCVA 6/60 or better qualifies for enrollment) * Acuity better than 6/120 (20/400) in the study eye (note that any acuity, uncorrected, corrected, pinhole, or BSCVA can be used for enrollment) * Currently on rifampin, rifabutin, ritonavir, long acting barbiturates, phenytoin, carbamazepine, or other drugs known to interact with voriconazole * Known allergy to study medications (antifungal or preservative) * No light perception in the affected eye * Not willing to participate