Fig. 20. Case 2: Infiltrative syndrome of presentation. Clinical appearance: left relative proptosis, diffuse periorbital subdermal infiltration, restricted extraocular movements, and firm orbits (A). Coronal CT scan shows diffuse contrast-enhancing abnormal soft tissue within both orbits surrounding the globes (B), extending posteriorly along the extraocular muscles and optic nerve sheaths. Orbital biopsy was consistent with metastatic adenocarcinoma from the bowel. Two months after orbital radiotherapy, the subdermal lid infiltrates were gone and her upper lid sulci reappeared. Proptosis was reduced, and extraocular movements had improved dramatically (C).