Difficulty in Management of Advanced Pediatric Orbital Tumor

Introduction: Tertiary care centers often manage pediatric orbital tumors, usually in advanced lesions and complex management. We report a case of a young boy with a malignant orbital tumor involving intracranial infiltration. Case presentation: A four-year-old boy had proptosis on the left eye for two months accompanied by blurred vision, pain, and often bleeds with ipsilateral nasal congestion. There was no history of trauma, eye disorders, systemic diseases, or growth disorders.  The physical examination showed stable vital signs, however a weak general condition and no enlarged regional lymph nodes. Visual acuity of the left eye was no light perception. It was a mass with protrusion of the left eye, swelling of the eyelid with an irregular surface, and a tendency to bleeds. The cornea was hazy with partly scaring, so we could not evaluate the posterior segment. MRI of the head presented a malignant soft tissue mass of the left orbital region with intracranial infiltration. The patient was given adjuvant chemotherapy however could not survive due to systemic complications. Discussion and conclusions: The definitive diagnosis for the orbital tumor was by histopathological examination. The investigation with CT scan or MRI imaging could be considered if not possible, and however, since the definitive diagnosis was still not assessed, it could affect the management. It was essential to have a definitive diagnosis to provide adequate treatment to patients.  Delayed and inadequate management could make malignant orbital tumors potentially life-threatening.