A filamentous fungal biofilm is a collection of hyphae and spores encased in a matrix, which has distinct developmental phases governed by complex molecular events. Resistance to antifungal drugs and components of the innate immune system remain the greatest threats to patients with filamentous fungal biofilms. There is increasing evidence that filamentous fungal biofilms play a role in a variety of ocular infections. Filamentous fungal biofilms may participate in ocular infections by allowing filamentous fungi to persist on abiotic surfaces that come in contact with the eye, and by direct biofilm formation on biotic surfaces of the eye. This review discusses the current understanding of the basic biology and clinical implications associated with filamentous fungal biofilms in ophthalmology.