Purpose: To compare the safety and efficacy of intrastromalvoriconazole injection with topical voriconazole in management of fungal corneal ulcer not responding to conventional therapy.Patients and methods: A comparative and randomized study performed on patients with resistant fungal keratitis.Half of the patients (Group A) were given intrastromal injection in the dose of 0.1 ml (50 microgram/0.1ml) in each injection , Half of the patients (Group B) were given topical voriconazole eye drops (1%) once hourly. Healing of keratitis was considered as primary outcome measure.Results: Each group included 35 eyes with resistant fungal keratitis. Complete healing of fungal keratitis was higher in group A (88.6%) than in group B (31.4%) and the difference was statistically significant (P0.05).Conclusion: Voriconazole topically might be effective for treatment of resistant fungal keratitis. Adding intrastromal injection to topical drops could significantly raise the healing rate and hasten the resolution period without significant complications related to injection.