A 1-year-old boy presented with an 8-week history of bilateral periorbital ecchymosis (‘raccoon eyes’). Physical examination of the orbits, including neurological examination, was normal. A mass was palpated in the right upper quadrant. US and MRI of the abdomen demonstrated a large right adrenal mass with hepatic metastases. Orbital MRI showed bilateral periorbital metastatic infiltration with involvement of the meninges (Fig. 1).

Fig. 1
figure 1

Orbital MRI. a Coronal T2-weighted fat-saturated image. b Axial contrast-enhanced T1-weighted image

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Neuroblastoma is the most common extracranial solid tumour of childhood and accounts for 8–10% of all childhood cancers. Periorbital ecchymosis due to periorbital metastasis complicates approximately 5.4% of cases [1]. It is probably related to obstruction of the palpebral vessels by tumour infiltration around the orbits. Periorbital ecchymosis is also a feature of skull trauma. Hence, diagnosis in these children can be delayed as this can arouse the suspicion of non-accidental injury [2].