Sphenoid sinus metastasis is extremely rare. Herein, we report a case of occult hepatocellular carcinoma with initial symptoms of decreased vision and headache, which were caused by sphenoid sinus metastasis. A 44-year-old man recently complained of bilateral decreased vision and headache. Head MRI showed a soft tissue mass in the sphenoid sinus. Pathological examination of the resected sphenoid sinus mass indicated metastatic carcinoma. Subsequently, F-FDG PET/CT and immunohistochemical analysis of the sphenoid sinus mass confirmed the hepatic origin of the primary lesion.