A 21-month-old girl was referred for worsening exotropia. On clinical examination, she was able to fix and follow objects with her right eye, and there was no response with the left eye. Leukocoria, a trace afferent pupillary defect, and intermittent exotropia were noted in the left eye. On dilated funduscopic examination, a peripapillary tumor extending through the fovea with secondary exudative retinal detachment was noted in the left eye. Subretinal and fine vitreous seeding was also noted (Figure 1A). The right eye was unremarkable. The patient was diagnosed with Reese-Ellsworth group Vb retinoblastoma in the left eye, with a normal systemic workup. Systemic chemotherapy was initiated with 4 agents (carboplatin, vincristine, etoposide, and cyclosporine) combined with local laser therapy initially planned for 9 cycles but extended to 11 cycles based on tumor nonresponse. Subsequently, 6 cycles of periocular carboplatin injections (20-mg dose) were administered. Despite aggressive globe-conserving treatment, the tumor progressed (Figure 1B). Salvage treatment with intra-arterial melphalan infusion was administered at a 3-mg dose initially and then a 7.5-mg dose. On follow-up examination, vitreous hemorrhage was noted obscuring the tumor, with tumor progression evident on echographic imaging. The left eye was enucleated (Figure 1C).