Nectorizing ulcerative keratitis in a young woman with no history of contact lens wear or previous eye surgery or trauma. Progressive worsening over 4 consecutive weeks despite multiple doctors, antibiotics, antifungals, and antivirals. Ocular rosacea contributed to the process. Surgical intervention is needed to remove presumed infection and to treat severe perforation treated previously with tissue adhesive. Referred to Alan N. Carlson MD, Professor of Ophthalmology, Duke Eye Center, Durham NC to manage this case.