Fungal keratitis—an infection of the cornea caused by yeast or filamentous fungi—is a leading cause of visual impairment, blindness and eye-loss worldwide. Infection progression most commonly follows epithelial cell damage, leading to spore adhesion to the ocular surface, germination, hyphal growth and finally biofilm formation within the corneal stroma. Abiotic fungal biofilms may also be introduced to the eye directly via contaminated contact lenses. Interestingly, not all keratitis-causing fungi form biofilm (when grown in vitro), and it is not essential for severe disease manifestation. However, biofilm-forming fungi modulate the immune response, and confer greater resistance to drug and environmental stresses, such as antifungals and UV irradiation. Herein, we report fungal keratitis pathogenesis from a pre-clinical and clinical perspective, with and without contact lens propagation. We further present current and emerging treatment strategies in the context of biofilm eradication, using approaches such as novel drug delivery systems, immunomodulation and light-mediated therapies.