Rare Presentation of Retinoblastoma as Orbital Cellulitis in a Two-Month Infant: A Case Report

A two-month male infant presented to the ophthalmology outpatient department with left eyelid swelling and redness for the past 11 days.The patient had a previous history of febrile illness, raising clinical suspicion of orbital cellulitis.Examination under anaesthesia was performed, which showed a normal right eye, while the left eye had proptosis, watery discharge, conjunctival chemosis, hazy cornea, and white pupillary reflex.CT scan revealed dense calcifications, highly suggestive of retinoblastoma, with scleral involvement at the 4 o'clock position and no optic nerve invasion.MRI of the brain and orbit demonstrated a hypo-intense retinal-based mass in the vitreous cavity with periscleral and perioptic spread, which confirmed the suspicion of retinoblastoma.Based on the clinical and radiological findings, a diagnosis of Group E retinoblastoma with scleral extension was made.The infant was planned for two cycles of chemotherapy followed by enucleation of the left eye.This case highlights the diagnostic challenge presented by retinoblastoma which can present as an inflammatory condition, such as orbital cellulitis, and emphasises the importance of considering malignancy in atypical ocular inflammations, supported by extensive imaging evaluation.