We analyzed the clinical constellation of signs and symptoms and the radiographic studies of 17 patients with histologic verification of cavernous sinus metastases. Although most patients presented with acute, unilateral, painful ophthalmoplegia, and with a rapidly progressive course, the clinical diagnosis of metastatic disease was often delayed. This was probably due to the fact that, in the majority of patients, cavernous sinus symptoms were either the first expression of an unknown malignancy or the first manifestation of metastatic disease in those with a known primary. Computed tomography was found to be an indispensable diagnostic aid. In 16 of the 17 patients CT established the presence of an enhancing mass in the cavernous sinus sometimes associated with bone erosion. Thin section, contrast enhanced high resolution CT in axial and coronal projections represents the imaging procedure of choice for metastatic disease to the cavernous sinus. © 1985 Raven Press.