‘Raccoon eyes’ revisited

Abstract

A 1-year-old boy presented with 5 weeks of periorbital ecchymosis, without associated trauma. Contrast-enhanced head and face CT reveals extensive osseous metastases involving facial bones and skull with spiculated periosteal reaction along the orbital walls (Fig. 1, arrows). Subsequent evaluation with iodine-123 metaiodobenzylguanidine (I-MIBG) (Fig. 2) confirms a right paraspinal neuroblastoma (arrow) with widespread tumoral involvement of cortical bone and bone marrow. Almost 60% of patients with neuroblastoma will have metastases at diagnosis. Periorbital metastases cause proptosis or orbital ecchymosis, resulting in the clinical raccoon-eye appearance. Ophthalmic involvement, reported in 10% to 43% of cases of neuroblastoma, may also manifest as opsoclonus, Horner syndrome, ocular motility defects or blindness [1].