A 34-year-old black male presented with marked unilateral proptosis and pain in the left eye. Visual acuities were OD 6/7.5 (20/25) and OS 6/120 (20/400). His left eye was exophthalmic , had a Marcus Gunn pupil, and exposure keratitis. Sectorial pallor and a decreased Kestenbaum count were evident on the left optic nerve head. A tentative diagnosis of orbital meningioma was made and later confirmed. Optometric management of the patient, including appropriate screening tests and referrals, are discussed.