Purpose To report preseptal cellulitis and orbital bone destruction as ocular manifestations of nasal cocaine abuse. Method Case report. We examined a 40-year-old male nasal cocaine abuser with diabetes mellitus and with signs of preseptal cellulitis. Computed tomographic imaging of the cranium was performed, and a nasal cavity biopsy specimen was obtained. Results Computed tomographic findings showed extensive cartilaginous and bony destruction involving the nasal septum and medial wall of the left orbit, and the nasal biopsy specimen disclosed inflammatory exudate with neutrophils. Conclusions Nasal cocaine abuse induces mucoperichondrial ischemia and may be associated with cartilaginous and bony destruction as well as preseptal cellulitis.