Retinoblastoma physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Common physical examination findings of retinoblastoma include leukocoria, retinal detachment, vitreal opacification and hemorrhage and the diagnosis is challenging.
Indirect Opthalmoscopy
Leukocoria produced by retinoblastoma lesions can often be missed by direct ophthalmoscopic examination through an undilated pupil. According to a study, Leukocoria was detected by direct ophthalmoscopy on undilated examination in 30% of cases versus 100% in indirect opthalmoscopy after pupillary dilation.[1]
In children, it is usually done under anesthesia (EUA-Examination Under Anesthesia). Pupils are dilated to look at the retina through the lens and pupil. The tumor typically appears as creamy pink or snow white mass projecting in to the vitreous. The number, size, location (anterior or posterior), laterality, disc diameter, subretinal fluid or seeds noted and degree of exophthalmos are measured. Detailed mapping is done with appropriate diagrams and description (relation with ora serrata, optic disc and macula).
However, in certain cases with retinal detachment, vitreal opacification and hemorrhage, the diagnosis is difficult and challenging.
Though it is used to confirm the diagnosis, further diagnostic studies like ocular ultrasound and imaging studies are required to classify (stage) the tumor which is very important to choose the appropriate treatment modality.
Age-appropriate visual acuity testing should be performed monocularly. External examination should rule out proptosis and signs of orbital cellulitis. Slit lamp examination should look for ciliary injection, pseudohypopyon, or signs of secondary glaucoma. The presence or absence of an afferent pupillary defect should be determined. If there is any suspicion for retinoblastoma, the patient should undergo an examination under anesthesia. An examination under anesthesia with careful scleral depression is necessary to confirm the diagnosis of retinoblastoma as well as to determine the exact location and extent of the tumor(s) and the tumor staging. Photographic documentation for future comparison is recommended. Complete retinal examination of both eyes is necessary to rule out bilateral disease
References
- ↑ Canzano JC, Handa JT (1999). "Utility of pupillary dilation for detecting leukocoria in patients with retinoblastoma". Pediatrics. 104 (4): e44. PMID 10506269. Retrieved 2012-05-29. Unknown parameter
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