An 18-month-old toddler presented with fever and tender swelling of right eye for 10 days (Fig. 1). We suspected orbital cellulitis due to local signs of inflammation. Investigations were Hb 10 g/dL, platelet-count 336 x 103/L, WBC 17.6 x 109/L (85% neutrophils), and C-reactive protein 56 mg/L. The puffiness of eye reduced, though did not resolve completely following 5 days of intravenous antibiotics. Cultures were sterile. CT demonstrated calcified mass in the posterior segment of eye, with optic-nerve thickening (Fig. 2). Examination under anesthesia suggested retinoblastoma. CSF and bone marrow examination were unremarkable. He received three cycles of chemotherapy, followed by enucleation, further nine cycles of chemotherapy, and orbital radiotherapy (stage III disease). Histopathology confirmed retinoblastoma. Child is well one year following treatment.

Fig. 1 Retinoblastoma presenting as orbital cellulitis of the right eye in an 18-month-old boy.

Fig. 2 CT scan showing intraocular calcified mass in the right eye (solid arrow) with optic nerve thickening (broken arrow).