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SUMMARY A 61-year-old male presented with a rapidly progressive exophthalmos from small cell lung cancer metastatic to the right orbit. His vision in that eye was 20/200, and his intraocular pressure was 36 mmHg. The orbital metastasis responded dramatically to chemotherapy. One week after starting the chemotherapy the patient did not have exophthalmos, his vision was 20/20, and three weeks later the intraocular pressure was 12 mmHg.Small cell lung cancer (SCLC) is one of the most aggressively metastatic tumours.' It is the fifth leading cause of cancer death in the US, and only 1 to 2% of patients with disseminated disease at diagnosis achieve lasting remissions.2 This report describes a patient who presented with a rapidly progressing exophthalmos from an SCLC and his good response to chemotherapy. Case reportA 61-year-old white male developed acute swelling of his right eyelids, and a diagnosis of preseptal cellulitis was made. The patient did not respond to antibiotics, so he was referred for further examination and treatment. On presentation he had a fullness of the right eyelids and temporal fossa. The globe was proptosed by about 10 mm and embedded in an indurated tumour mass that raised the conjunctiva. The preauricular node was enlarged on the right. The visual acuity was 20/200 in the right eye, 20/30 in the left eye, and there was a 2+ afferent pupillary defect in the right. The intraocular pressure was 36 mmHg in the right eye and 12 in the left.