A 60-year-old woman with a history of penetrating keratoplasty in her right eye due to corneal herpetic infection 1 year earlier was admitted because of visual disturbances and ocular pain. Slitlamp examination revealed an epithelial defect with corneal infiltration (Figure, A). Corneal scrapings were taken for smear and culture, and Candida albicans was isolated. We asked our pharmacology service for amphotericin B eyedrops but were informed of solubility and stability problems with the actual presentation of this drug. Treatment with topical voriconazole, 1%, administered every hour and oral voriconazole at a dosage of 200 mg twice daily was started. After 1 month the lesion had not progressed but there was no change in corneal infiltration, and cultures remained repeatedly positive for C albicans with no evidence of viral infection (Figure, B). Therefore, after obtaining the patient's consent and permission of sanitary authorities, we decided to apply topical caspofungin, 0.5%, every hour. To obtain the eyedrops, 1 vial of 50 mg of caspofungin acetate was diluted in 10.5 mL of sterile normal saline; all eyedrops were freshly made daily, kept at 4°C, and protected from light. One week later, clinical improvement was observed and cultures revealed no growth (Figure, C). Treatment with topical caspofungin was progressively decreased over 3 further weeks. Following the completion of treatment, complete healing of the corneal epithelium and resolution of the corneal infiltrate were observed, although the corneal opacity persisted (Figure, D). There was no evidence of ocular toxic effects and no recurrence of fungal keratitis over a follow-up period of 6 months.