This 51-year-old man presented with acute onset of binocular diplopia, injected eyes, and periocular swelling that was initially diagnosed as episcleritis but worsened despite lubrication and topical steroids. Examination was remarkable for a restrictive strabismus, right upper and lower eyelid retraction, and right greater than left inferior chemosis. Additional imaging and serology testing confirmed the diagnosis of thyroid eye disease (TED). In the early presentation of thyroid eye disease, patients may experience chemosis, conjunctival injection, and eyelid swelling secondary to orbital congestion. For more information on TED, see the EyeRounds TED tutorial.