Keratomycosis remains a difficult management problem. Fungal infection is often brought on by corneal injury accompanied by contamination with vegetable matter. There is a high frequency of such infection in migrant workers who pick oranges, rice, tea, and other crops, and these are often people who may not understand the need for follow-up or have access to continuing care. The medical treatment of fungal keratitis typically requires four to six weeks of intensive topical antifungals, and sometimes takes longer. For many patients, this is impractical or even impossible, and a reliable surgical alternative such as lamellar keratoplasty (LKP) is often preferable. In many cases, lamellar surgery may be superior even to medical therapy for the treatment of fungal keratitis. Lamellar keratectomy and conjunctival flap can greatly aid the treatment of fungal keratitis. Lamellar keratoplasty can also play an important role in the surgical management of acute and subacute resistant fungal keratitis, and in removal of residual fungal scars. It replaces PKP in partial-thickness corneal ulcers. The procedure is simple to perform, provides better optical outcomes, has fewer complications, involves a shorter recovery time, and requires fewer postoperative medications. Success rates of LKP for acute disease are encouraging.