Background: Onychomycosis, a fungal infection of the nail, is considered one of the most prevalent disorders of the nail. Objective: The aim of the present study is to evaluate the efficacy of the long pulsed Nd:YAG laser with or without topical terbinafine 1% cream in the treatment of onchomycosis. Methods: Comparative prospective interventional randomized control study was conducted on 45 adult patients with finger nail onychomycosis. Results: Our results confirmed the efficacy of Nd:YAG laser therapy combined with a topical antifungal agent, as the highest efficacy rate of clinical cure was observed in group B (73.3%)followed by group C (66.7%) and then group A (33.3%) also there was a statistically significant higher percent of mycological cure in group B (60.3%) followed by group C (53.3%) then group A(13.3%).