Bumpy muscles.

A 63-year-old man developed bilateral conjunctival injection and irritation followed by periocular discomfort and diplopia. Within weeks left proptosis and intermittent fever were noted. Orbital CT scan showed bilateral nodular enlargement of multiple extraocular muscles. Fine needle aspiration biopsy of the extraocular muscles revealed neoplastic cells compatible with a renal cell carcinoma. The bilateral extraocular muscle metastases were the initial manifestations of the underlying malignancy.