Purpose

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Methods

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Results

M.F.S.C., a 3-year-old female, presented with a 12-day history of a firm, progressively enlarging left lower eyelid nodule, initially managed as chalazion. Examination showed a 15-mm, solid, non-pulsatile, inferotemporal mass causing superomedial globe displacement. Orbital MRI revealed an anterior, extraconal, lobulated, well-defined lesion in the inferior and lateral segments, compressing the globe and rectus muscle insertions without infiltration. Five days later, transconjunctival excisional biopsy with frozen section confirmed malignancy (narrow superior margin). Surgery involved isolating the inferior rectus and inferior oblique (IO) muscles, with IO disinsertion and subsequent reinsertion. Diagnosis: Embryonal Rhabdomyosarcoma (RMS), Group III (macroscopic residual disease). Treatment included 13 chemotherapy and 23 radiotherapy sessions. At 4-month follow-up, uncorrected visual acuity remained 20/30, with limited vertical motility, centered Hirschberg, and no recurrence.

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Conclusion

Pediatric orbital RMS frequently mimics inflammatory conditions, leading to critical diagnostic delays. In this case, infratemporal fossa extension represents an atypical presentation where MRI was superior to CT in delineating deep invasion. The surgical approach – via lateral canthotomy and transconjunctival access – was decisive for oncological control and motor preservation. Although infiltrative tumors near the globe pose technical complexity, globe preservation was achieved despite narrow margins. Furthermore, coordinated multimodal management ensured a favorable outcome despite the Group III classification by Intergroup Rhabdomyosarcoma Study. Ultimately, early suspicion of refractory eyelid lesions and a multidisciplinary approach are essential to achieve cure with functional viability.

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Additional Authors

First name	Last name	Base Hospital / Institution
Raquel	Bezerra	Instituto de Oftalmologia Marco Rey (IOMR)
Maria Luiza	Maranhão	Universidade Potiguar (UnP)

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