Retinoblastoma physical examination: Difference between revisions
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==Eyes== | ==Eyes== | ||
* Age-appropriate visual acuity testing should be performed monocularly. | :* Age-appropriate visual acuity testing<ref>http://eyewiki.org/Retinoblastoma#Physical_Examination</ref> should be performed monocularly. | ||
* External examination should rule out proptosis and signs of orbital cellulitis. | :* 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. | :* 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. | :* 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. | :* 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. | :* Complete retinal examination of both eyes is necessary to rule out bilateral disease. | ||
* '''Fundus examination''' | |||
:* Retinoblastoma classically presents with one or multiple nodular, white or cream colored masses often associated with increased vascularization. There are two primary clinical patterns of retinoblastoma growth. | |||
::* 1. If the tumor grows forward into the vitreous it is known as an endophytic tumor. This form of retinoblastoma often shows vitreous seeding, which causes vitreous haze and opacities. This can eventually progress to involve the anterior chamber and can cause secondary glaucoma and inflammation. | |||
::* 2. When the tumor shows a growth pattern that extends beneath the retina (subretinal) it is described as an exophytic tumor. These tumors can cause exudative retinal detachments and may be associated with significant subretinal seeding. | |||
==References== | ==References== | ||
Revision as of 19:59, 3 September 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Retinoblastoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Retinoblastoma physical examination On the Web |
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American Roentgen Ray Society Images of Retinoblastoma physical examination |
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Risk calculators and risk factors for Retinoblastoma physical examination |
Overview
Common physical examination findings of retinoblastoma include leukocoria, retinal detachment, vitreal opacification and hemorrhage and the diagnosis is challenging.
Eyes
- Age-appropriate visual acuity testing[1] 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.
- Fundus examination
- Retinoblastoma classically presents with one or multiple nodular, white or cream colored masses often associated with increased vascularization. There are two primary clinical patterns of retinoblastoma growth.
- 1. If the tumor grows forward into the vitreous it is known as an endophytic tumor. This form of retinoblastoma often shows vitreous seeding, which causes vitreous haze and opacities. This can eventually progress to involve the anterior chamber and can cause secondary glaucoma and inflammation.
- 2. When the tumor shows a growth pattern that extends beneath the retina (subretinal) it is described as an exophytic tumor. These tumors can cause exudative retinal detachments and may be associated with significant subretinal seeding.