How to spot Retinoblastoma?

It is important to learn the early signs of retinoblastoma. Early detection, diagnosis and treatment depends on it. The most common early signs (see Table 1) of retinoblastoma are: Something white in the eye, often first noticed by parents. Confirm by conducting a red reflex test (see p. 23) Squint: one eye turns in or out (not as common). Signs of more advanced retinoblastoma include: Forward displacement of the eye (proptosis) A visible tumour (fungating mass) involving just the globe, or extending to the orbit and/or the face. Less common signs of retinoblastoma include: Poor vision, whether noticed by the parents or a health worker Nystagmus (constant eye movements) Hyphaema (bleeding into the anterior chamber) Pseudohypopyon (cells in the anterior chamber appearing as a layered white material) Periocular inflammation Phthisis bulbi (shrinkage of the globe) Raised pressure in the eye (glaucoma) Enlargement of the globe Change in iris colour (heterochromia)

	What the parents say, or what you can see	Could this be retinoblastoma?
Listen to the child’s carer	The parent/carer says they saw something white in the eye	Yes
Look at the child’s eyes	The eyes look normal but the parent/carer says they saw something white in the eye	Yes
	The eyes are not looking in the same direction; they are not straight	Squint is quite common in children It is rarely due to retinoblastoma
	One of the pupils is not black; it may be white or yellow-orange	This could be cataract or retinoblastoma
	One of the eyes is bigger than the other or bulges forward	This may be proptosis due to advanced retinoblastoma
Examine the pupil and red reflex	Look at the pupils. They should be black. Do a red reflex test (p. 23)	Suspect retinoblastoma if anything in the pupil looks abnormal

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