A 65-year-old man presented with worsening right eye pain and purulent discharge. He reported being hit in the face by a tree branch several days prior. His medical history was notable for HIV, with a last known CD4 lymphocyte count of 112 cells/mm3 and variable adherence to antiretroviral therapy. At an outside hospital, cultures were obtained, and treatment was initiated with ofloxacin eye drops, 0.3%, ciprofloxacin hydrochloride ointment, 0.3%, and oral moxifloxacin hydrochloride, 400 mg daily. His symptoms worsened, and he was referred 3 days later for further evaluation.