Surgical exploration revealed that the nodule was an abscess. The scleral buckle was initially not disturbed because of significant necrosis of the sclera and the risk of globe rupture. Cultures yielded Aspergillus fumigatus, and topical 0.15% amphotericin B and oral ketoconazole were initiated. After a lack of clinical response to a 4-week course of therapy, itraconazole was substituted for ketoconazole in hopes of improving intraocular penetration. A continued lack of clinical improvement led to uncomplicated scleral buckle removal 1 month later. During the next 4 months, despite multiple debridements and continued use of topical amphotericin B and oral itraconazole, the infection continued to spread counterclockwise around the eye (Figure 2). After learning of the investigational use of voriconazole, we obtained institutional review board approval of voriconazole use on a compassionate basis. Other antifungal agents were discontinued, and treatment with oral voriconazole, 200 mg twice a day, was begun. After 1 week of treatment, ocular tenderness and left-sided headache disappeared. Redness of the eye improved during the next 3 months (Figure 3).