Nasopharyngeal carcinomas (NPC) have a low incidence in western countries, but are endemic in South China where the incidence is 19.7 per 100 000, M: F ratio of 2:1 (1). It has a bimodal peak at presentation of 16–20 and 46–50 years (2). Due to the nasopharynx being a silent symptom area, they have an indolent course and the diagnosis is usually made at an advanced stage. Aetiological factors have been linked to genetic, environmental, dietary factors (nitrosoamines) and the Epstein Barr virus (3). We present a case of an unusual presentation of nasopharyngeal carcinoma with bilateral orbital invasion.