Many coral reefs in the Caribbean, and elsewhere, have undergone changes from hard coral to fleshy algal dominance over the past two decades which has often been interpreted as a localized response to eutrophication and fishing. Here, data on the abundance of hard corals and algae from lagoonal patch reefs distributed throughout a large (260 km2) remote reef atoll located approximately 30 km offshore from the sparsely-populated coast of Belize, Central America, are compared with a study of these patch reefs conducted 25 years previously. Data and observations indicate that these patch reefs have undergone a major change in their ecology associated with a 75% reduction in total hard coral, a 99% loss in the cover of Acropora cervicornis and A. palmata, and a 315% increase in algae, which are mostly erect brown algae species in the genera Lobophora, Dictyota, Turbinaria and Sargassum. Such changes have been reported from other Caribbean reefs during the 1980s, but not on such a remote reef and the present changes may be attributed primarily to both a disease that began killing Acropora in this region in the mid 1980s and a reduction in herbivory. The low level of herbivory may be attributable to the disease-induced loss of the sea urchin Diadema antillarum in 1983, or fishing of herbivorous fishes, but both explanations are speculative. The present density of fisherfolk is low, and their efforts are not targetted at herbivorous fishes, and population densities of D. antillarum 14 years after the mortality are <1 individual per 1000 m2, but there is no comparative data from before the die off. There is, however, no indication that these major changes occurred on the fore reef, because A. palmata is abundant and erect algal abundance is low. We suggest that reported changes in other Caribbean reefs are not necessarily or exclusively influenced by local human factors such as localized intense eutrophication or fishing.