We treated 11 episodes of bulbar conjunctival necrosis that occurred in ten patients after therapy for suppurative keratitis with topical fortified aminoglycosides. Chemosis and mucous discharge preceded the development of an area of conjunctival pallor, which stained with fluorescein and was 5 to 10 mm from the corneoscleral limbus. Typical lesions developed in the inferior bulbar conjunctiva after a mean of 4.8 days and 112 mg of gentamicin sulfate (109 drops). The fortified aminoglycoside was the only agent common to all cases. The conjunctival defects healed completely between five and 13 days after treatment was modified to reduce or eliminate aminoglycoside exposure.