Nasopharyngeal carcinoma (NPC) is a rare malignancy worldwide. It is the fifth most common cancer among the Malaysian male. NPC is complex and unique in terms of its initial presentation. The patient usually presents late when the NPC is already in its advanced stage due to unusual and confusing nature of its manifestation which often misleads the clinician. Initial presentation of vision loss or impairment is rare in NPC. Up to date, there are only 9 reports of NPC cases presenting initially with impaired vision. We report a case of NPC with an uncommon initial presentation of bilateral visual impairment.