Visual acuity without correction was 20/25 OU. Ocular motility was normal. The left eye and adnexa were normal. The right lower eyelid showed minimal edema and mild redness, which was worse nasally (Figure, A). There was +3 large vessel bulbar conjunctival injection that was greater nasally. The inferior palpebral conjunctiva was intensely inflamed and had 2 areas of ulceration down to the tarsus (Figure, B). A narrow tract of deep tissue necrosis with a blind end originated inferior to the caruncle; it probed inferonasally to a depth of approximately 7 mm. The anterior segment was otherwise normal. An orbital computed tomographic scan showed preseptal and postseptal edema with inflammatory changes in the nasal extraconal fat, without discrete abscess. Culture of the drainage grew MRSA susceptible to vancomycin hydrochloride, rifampin, and clindamycin phosphate but resistant to penicillin and cefazolin sodium. The patient was treated for 7 days with intravenous vancomycin and tobramycin sulfate as well as oral rifampin and then for 7 days with oral trimethoprim sulfa double strength with clinical resolution. Nasal cultures for MRSA were negative.