Retinoblastoma physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Pediatricians can screen for vision and/or life threatening eye diseases. The minimal "well baby" screening for newborns is done during the first three months of life should include the following exams:
- The Red Reflex: checks for a normal red reflection in the eye that occurs when light travels inside the eye, hits the retina and the blood tissue, and is reflected back.
- The Corneal Light Reflex: when a light is shined into each cornea a symmetrical beam of light is reflected back in the same spot on each eye. This helps to determine whether the eyes are crossed.
- An Eye Examination: to check for any structural abnormalities. From six to twelve months of age, the eyes' ability to fix and follow objects both individually and together is evaluated. Between the ages of three and five, the examination of the eyes is coupled with testing for visual acuity, color vision and depth perception.
Parents can observe the red reflex can be seen by dimming the room lights and using a flashlight to shine light directly into the child's eyes.
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.
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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