Retinoblastoma: Evaluation and Diagnosis

In the United States and other developed nations, the most common presenting findings in intraocular retinoblastoma (RB) are leukocoria or cat’s eye reflex (45%), strabismus (25%), inflammatory symptoms (pseudo–preseptal cellulitis) (10%), and poor vision (10%). For several reasons discussed elsewhere, in developing nations, retinoblastoma tends to be more advanced at presentation, with a greater proportion of cases with extraocular disease. A practical stepwise approach specifically to evaluate a child suspected to have retinoblastoma includes detailed history taking, initial office examination, and focused ophthalmic ultrasonography, followed by examination under anesthesia and neuroimaging, if necessary. This approach is merely a guide that can be modified as needed based on the clinical setting.