We report a case of a 71 year old female who presented with redness, pain and periocular swelling in the left eye of 3 months duration and decreased vision and protrusion since 15 days. Previous ophthalmological history was unremarkable. The vision was PL negative. Examination showed moderate axial proptosis, mild ptosis, fullness of the eyelids, and a chemosed, prolapsed conjunctiva. Fundus examination showed a branch vein occlusion of the inferotemporal vein. There was total ophthalmoplegia OS. A provisional diagnosis of pseudotumour was made after basic investigations, and steroid therapy was initiated, but the patient showed little response. CT orbit showed left eye proptosis with minimal fat stranding and superior ophthalmic vein thrombosis which was confirmed by MRI. She also had an intracranial infarct which was picked up on MRI. Due to multiple vaso occlusive sites, and the lack of response to steroid therapy, she was referred for a haematological work up. Superior ophthalmic vein thrombosis, although rare, can be a harbinger of cavernous sinus thrombosis, hence the need for an urgent and detailed evaluation of orbital thrombosis.