Fungal keratitis, the world's second leading cause of blindness after cataracts, is one of the most common causes of ocular mycosis. The study's goal was to compare the efficacy of traditional topical, systemic, and intracameral voriconazole injections in treating keratomycosis visual and structural outcomes. Material and methods An observational study was conducted at a hospital on 45 patients with smear-positive fungal keratitis in 45 eyes. Patients were split into two groups: Systemic topical with oral ketoconazole 150 mg was given to Group I, while intracameral voriconazole 60 gm/0.1 mL was given to Group II. Results: Fusarium is the name given to the most common fungal organism. The mean final visual acuity (VA) in Groups I, II, and III was 1.15 0.32, 1.45 1.04, and 1.21 0.37 logMAR, respectively. The mean VA improvement was 0.44 0.06, 0.02 0.61, and -0.17 0.02 logMAR without statistical significance (p = 0.8). There was a significant difference in VA between the final postoperative follow-up period and baseline in Group I cases (p = 0.0018). There was no difference in VA between the final postoperative follow-up period and baseline in Group II (p = 0.0561) or Group III (p = 0.1605) cases. There was no statistically significant difference in time between the onset of hypopyon and the mean time to infection healing (p = 0.1). In each group, three cases were perforated, and keratoplasty was performed. Culture was not found in these perforated cases. The isolated organisms in the corneal buttons were identified as Aspergillus species (n = 2) and Fusarium species (n = 4). Conclusion: The VA differences between the three methods were not statistically significant, implying that none of the treatments was superior to the others (inter-group). There was, however, a significant difference in VA between the final postoperative follow-up period and baseline in Group I (p = 0.0018). In Groups II (p = 0.0561) and III (p = 0.1605), there was no difference in VA between these time intervals. The Group I method is more effective for VA, according to within-group or intra-group analysis. The duration of intracameral voriconazole in the anterior chamber, the absence of hypopyon drainage, and the individual clinical response all contributed to the success rate of the method.