We have described a condition termed tight orbit syndrome, characterized by the eyelids pressing firmly against the globe, limiting globe exposure during tonometry, gonioscopy and surgery, and a high-pressure glaucoma which is extremely difficult to manage. Secondary causes of globe tightness, including thyroid ophthalmopathy due to increased orbital soft tissue volume, orbital varix and arterio-venous fistula, have been well reported and may have analogous pathophysiology to tight orbit syndrome. Patients with tight orbit syndrome have narrow palpebral apertures, and IOP measurement with the Goldman applanation tonometer is difficult. If applanation tonometry is not possible, then Tonopen, rebound tonometry or pneumotonometry may be required. Patients have bilaterally high IOP and a poor response to medical, laser and surgical treatment .