A conjunctival pseudomembrane obscuring the cornea was removed on the second hospital day and sent for pathologic analysis (Figure 1C), and a symblepharon discovered medially in the left eye was lysed. Neomycin sulfate, polymyxin B sulfate, and dexamethasone ophthalmic ointment was initiated. Four days after admission, MRC-5, A549, and primary rhesus monkey kidney cell cultures from the eye and ear discharge showed viral cytopathic effect consistent with vaccinia. All other bacterial and viral cultures were negative. The Centers for Disease Control and Prevention and the public health department were notified and the vaccinia strain was identified by polymerase chain reaction. After diagnosis, when specifically questioned about any possible exposure to vaccinia, the patient recalled the potential for autoinoculation approximately 14 days prior to the positive culture. He suggested that at that time he may have touched his ear with a gloved hand contaminated by infected blood while performing phlebotomy on experimentally inoculated research mice. The patient had not been previously vaccinated. Because of rapid improvement and the late stage at diagnosis, cidofovir and vaccinia immunoglobulin therapy were not started.