Diffuse lamellar keratitis is an early postoperative problem that initially appears as an inflammatory response beginning in the corneal stroma and progressing to the flap interface. The day 1 examination is typically diagnostic and management is aggressive topical steroids, careful monitoring, and in aggressive cases oral steroids. If stage 3 with collection of cells in the flap interface is identified, lifting the flap with gentle rinsing is indicated. Outbreaks may be reduced through careful cleaning techniques of the sterilizer reservoir and avoidance of contaminants on instruments.