A 47-year-old woman with a history of metastatic neuroendocrine carcinoid tumor (NET) status in remission after liver transplant was hospitalized for workup of a new pancreatic mass concerning for recurrence. Several days into her hospital course, she developed acute-onset severe bilateral periorbital swelling, chemosis, and ophthalmoplegia as well as occasional flushing and palpitations. Her best-corrected visual acuity was 20/70 in both eyes. Pupils, intraocular pressure, and color vision were normal. She had bilateral proptosis to 20/21 mm by Hertel exophthalmometer, −3 restriction of extraocular movements in all directions of gaze, diffuse punctate epithelial erosions, and mechanical lower lid entropion secondary to severe chemosis in both eyes (Figure 1A). Anterior segment examination and dilated ophthalmoscopy results were otherwise unremarkable.