Retinoblastoma physical examination: Difference between revisions
Jump to navigation
Jump to search
Simrat Sarai (talk | contribs) No edit summary |
Simrat Sarai (talk | contribs) No edit summary |
||
| Line 23: | Line 23: | ||
*White reflex or cat's eye reflex | *White reflex or cat's eye reflex | ||
*Ocular examination (staging examination under general anaesthesia) can be easily performed using a surgical or binocular handheld slit lamp microscope, and includes anterior segment evaluation (cornea, anterior chamber and iris).<ref name="pmid22337189">{{cite journal| author=Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS et al.| title=Retinoblastoma. | journal=Singapore Med J | year= 2012 | volume= 53 | issue= 2 | pages= 128-35; quiz 136 | pmid=22337189 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22337189 }} </ref> Ocular examination is followed by indirect opthalmoscopy with indentation under full mydriasis to examine the entire retina. | *Ocular examination (staging examination under general anaesthesia) can be easily performed using a surgical or binocular handheld slit lamp microscope, and includes anterior segment evaluation (cornea, anterior chamber and iris).<ref name="pmid22337189">{{cite journal| author=Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS et al.| title=Retinoblastoma. | journal=Singapore Med J | year= 2012 | volume= 53 | issue= 2 | pages= 128-35; quiz 136 | pmid=22337189 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22337189 }} </ref> Ocular examination is followed by indirect opthalmoscopy with indentation under full mydriasis to examine the entire retina. | ||
*In over 90% of cases, direct visualization of the tumor by an indirect ophthalmoscope is diagnostic for retinoblastoma.<ref name="pmid25473349">{{cite journal| author=Pandey AN| title=Retinoblastoma: An overview. | journal=Saudi J Ophthalmol | year= 2014 | volume= 28 | issue= 4 | pages= 310-5 | pmid=25473349 | doi=10.1016/j.sjopt.2013.11.001 | pmc=PMC4250503 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25473349 }} </ref> | |||
*Ophthalmoscopic exam may be abnormal with findings of chalky white-gray retinal mass | *Ophthalmoscopic exam may be abnormal with findings of chalky white-gray retinal mass | ||
*The diagnosis of retinoblastoma is usually made during a dilated indirect ophthalmoscopic examination, performed under anesthesia. The characteristic finding is a chalky, white-gray retinal mass with a soft, friable consistency.<ref name="pmid2201000">{{cite journal| author=Abramson DH| title=Retinoblastoma 1990: diagnosis, treatment, and implications. | journal=Pediatr Ann | year= 1990 | volume= 19 | issue= 6 | pages= 387-95 | pmid=2201000 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2201000 }} </ref> | *The diagnosis of retinoblastoma is usually made during a dilated indirect ophthalmoscopic examination, performed under anesthesia. The characteristic finding is a chalky, white-gray retinal mass with a soft, friable consistency.<ref name="pmid2201000">{{cite journal| author=Abramson DH| title=Retinoblastoma 1990: diagnosis, treatment, and implications. | journal=Pediatr Ann | year= 1990 | volume= 19 | issue= 6 | pages= 387-95 | pmid=2201000 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2201000 }} </ref> | ||
Revision as of 15:43, 12 October 2015
|
Retinoblastoma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Retinoblastoma physical examination On the Web |
|
American Roentgen Ray Society Images of Retinoblastoma physical examination |
|
Risk calculators and risk factors for Retinoblastoma physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Common physical examination findings of retinoblastoma include white reflex or loss of red eye reflex, strabismus, proptosis, anisocoria, orbital cellulitis, hyphema, heterochromia iridis, poor vision, unilateral mydriasis, rubeosis iridis, vitreous hemorrhage, and fundocopic examination with findings of chalky white -gray retinal mass.
Physical examination
General Appearance
Children with retinoblastoma are generally well-appearing Children may appear cachectic in advanced cases
HEENT
- Nystagmus
- Strabismus or cross eyed or wall eyed
- Anisocoria
- Proptosis
- Poor vision
- Orbital cellulitis
- Hyphema
- Heterochromia iridis
- Unilateral mydriasis
- Rubeosis iridis
- Red, painful eye with glaucoma
- Vitreous hemorrhage
- White reflex or cat's eye reflex
- Ocular examination (staging examination under general anaesthesia) can be easily performed using a surgical or binocular handheld slit lamp microscope, and includes anterior segment evaluation (cornea, anterior chamber and iris).[1] Ocular examination is followed by indirect opthalmoscopy with indentation under full mydriasis to examine the entire retina.
- In over 90% of cases, direct visualization of the tumor by an indirect ophthalmoscope is diagnostic for retinoblastoma.[2]
- Ophthalmoscopic exam may be abnormal with findings of chalky white-gray retinal mass
- The diagnosis of retinoblastoma is usually made during a dilated indirect ophthalmoscopic examination, performed under anesthesia. The characteristic finding is a chalky, white-gray retinal mass with a soft, friable consistency.[3]
- The fundoscopic examination may show retinal detachment with retinal vessels visible behind the lens and may show vitreous and/or subretinal seeding. Intrinsic tumor calcification, tumor microvasculature, may also be seen. This examination permits complete visualization of the retina, identification of multifocal tumors and/or vitreous or subretinal seeding.
- The red reflex: checking for a normal reddish-orange reflection from the eye's retina with an ophthalmoscope or retinoscope from approximately 30 cm / 1 foot, usually done in a dimly lit or dark room.
- The corneal light reflex / Hirschberg test: checking for symmetrical reflection of beam of light in the same spot on each eye when a light is shined into each cornea, to help determine whether the eyes are crossed.
- Eye examination: checking for any structural abnormalities.
- Bryan Shaw helped develop a smart-phone app that can detect leukocoria in photos.
- Low-set ears may be present in 13q deletion syndrome
- Telecanthus may be present in 13q deletion syndrome
- Simian crease in the palms and broad thumb may be present in 13 q deletion syndrome
A thorough systemic examination is important as a pre-requisite for general anaesthesia, as well as to rule out 13q deletion syndrome,
References
- ↑ Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS; et al. (2012). "Retinoblastoma". Singapore Med J. 53 (2): 128–35, quiz 136. PMID 22337189.
- ↑ Pandey AN (2014). "Retinoblastoma: An overview". Saudi J Ophthalmol. 28 (4): 310–5. doi:10.1016/j.sjopt.2013.11.001. PMC 4250503. PMID 25473349.
- ↑ Abramson DH (1990). "Retinoblastoma 1990: diagnosis, treatment, and implications". Pediatr Ann. 19 (6): 387–95. PMID 2201000.