• A patient with advanced renal failure and bilateral exophthalmos was found to have urinary obstruction caused by retroperitoneal fibrosis, as well as bilateral orbital pseudotumors. Pseudotumor of the orbit, especially when bilateral, has been associated with a wide variety of systemic conditions. Although the association of pseudotumor and retroperitoneal fibrosis is uncommon, any patient with bilateral orbital pseudotumor and renal insufficiency should be examined for the possible presence of a treatable urinary obstruction.