Idiopathic orbital inflammation or orbital pseudotumor with intracranial extension is a rare condition. It consists of a nonspecific infiltrate of the fatty tissue of the orbit that extends through one or more foramina into the adjacent intracranial tissue. The lesion mimics an infectious or neoplastic lesion. The authors present a case involving the youngest patient yet reported with the broadest intracranial extension. Only 17 previous cases have been reported. The principal symptoms include decreased visual acuity and proptosis. Extension commonly develops through the superior orbital fissure into the middle cranial fossa and the cavernous sinus. The initial treatment is a regimen of high-dose steroids, with radiotherapy given in unresponsive cases.