PURPOSE: Although substantial morbidity is uncommon in preseptal cellu
litis, the incidence of severe infection resulting from group A strept
ococcal infection is increasing. METHODS: A 62-year-old man was initia
lly examined for preseptal cellulitis sustained after minor trauma to
his brow. The patient rapidly experienced shock and multisystem organ
failure. Intensive medical therapy prevented circulatory collapse and
death. RESULTS: A diagnosis of streptococcal toxic shock syndrome seco
ndary to group A beta hemolytic streptococcal infection was made based
on culture. results and clinical course. CONCLUSIONS: The ophthalmolo
gist plays an essential role in diagnosing this condition. Aggressive
and timely treatment are essential to preventing death.