Background: Retinoblastoma (RB) typically presents before age five; presentation beyond this age is uncommon but documented. We describe a 9-year-old Nigerian girl who presented with a fungating orbital mass secondary to advanced unilateral RB. The child had an 11-month history of progressive leukocoria and proptosis initially misinterpreted as an infection, followed by multiple delays at the primary-care level and prolonged use of traditional remedies. Factors contributing to the delay in diagnosis and timely presentation for specialist care included poor awareness of early RB signs, misdiagnosis, delayed referral, and sociocultural practices.
Main discussion: The case underscores how limited community awareness, mismanagement at the primary-care level, and reliance on traditional remedies prolong the diagnostic timeline until curative treatment is less feasible. These case-specific delays illustrate broader systemic gaps in early detection and referral in LMICs.
Conclusion: While advanced treatment and genetic tools hold promise, survival for RB in LMICs still depends on timely diagnosis and prompt intervention. This case highlights the urgent need for improved early recognition and referral systems, while acknowledging that late-age diagnosis has also been reported globally. Bridging the awareness gap and investing in sustainable early detection strategies must be prioritized to close the survival divide between high- and low-income settings.

Retinoblastoma, Late presentation, Pediatric cancer, Early diagnosis, Low-resource settings, Ocular oncology