Case of bilateral retinoblastoma

1. Case Presentation
Dr. Amreen H. Deshmukh

2. Chief Complaints
A 2 year old female child was brought
by parents to OPD with chief
complaints of
 White opacity in both eyes since birth
 Poor vision in both eyes since birth
 Forward protrusion, redness and
watering from right eye since 15 days

3. History of Present Illness
 History narrated by parents
 Parents had noticed white opacity in both
eyes since birth.
 It increased in size progressively.
 No medical advice was sought for the
same
 Child did not look at her mother or smile
 She did not reach for objects held in front
of her
 H/o repeated falls

4. Contd.
 15 days back she developed forward
bulging of right eye associated with pain,
redness and watering
 It increased progressively to reach
present state.
 Associated with malaise, lethargic
behaviour
 No h/o fever
 No h/o squinting in either eye
 No h/o previous attacks of pain, redness
and watering
 No h/o NICU admission, Oxygen therapy

5. Contd.
 No h/o maternal infection during
pregnancy
 Not a/w mental retardation
 No h/o pets like dogs or cats
 No h/o recurrent attacks of cold,
sinusitis
 No h/o convulsions.

6. Past History
 No h/o hospital admissions in past
 No h/o major surgeries in past
 No h/o TB, bronchial asthma

7. Family History
 No h/o consanguinity
 No h/o similar illness in siblings
 No h/o eye loss in other family
members
Father
16 yrs
Female
11 yrs
Female
Mother
6 yrs
Male
2 yrs
Female

8. Birth History
 FTND
 At home
 Baby cried at birth
 Birth weight- 2.5 kg
 No h/o NICU admission, Oxygen
therapy
 No vaccination given at birth

9. Immunization History
 Well immunized till date
 Status of BCG vaccination- uncertain

10. Developmental History
 Milestones delayed
 Verbal and motor both

11. Personal History
 Sleep- disturbed
 Appetite- Reduced, breast fed,
Weaning started
 Bowel/ bladder habbits- altered

12. General Examination
 Patient is conscious, irritable
 Child appears malnourished
 GC- fair
 Pulse- 102/min
 B. P. – 100/60 mm of Hg
 R. R. – 18/min
 e/o Pallor +

13. Contd
 No e/o icterus, cyanosis, clubbing
 No e/o lymphadenopathy, cervical or
pre-auricular
 No e/o pedal oedema

14. Systemic Examination
 CVS- S1, S2 heard
 RS- AEEBS
 P/A- soft, non-tender
 CNS- Patient is conscious

15. Ophthalmic Examination
 Patient is highly uncooperative for
examination
 Head Posture- Normal
 Facial Symmetry- altered d/t Proptosis
RE
 Eye alignment- cannot be judged
 EOM- Right eye- Restricted
Left Eye- Full and free in all
directions of gaze

16. Proptosis Evaluation
 RE Axial Proptosis
 Rest measurements not possible
 Palpation
◦ Non- reducible
◦ Firm to hard consistency

17. Right Eye Left Eye
Eyebrows Normal Normal
Eyelids Edema+ Normal
Eyelashes Matted Normal
IPF Increased Normal
Conjunctiva Conjunctival Congestion
severe Chemosis
Circumcorneal
Congestion

18. Right Eye Left Eye
Cornea Hazy d/t Exposure
Keartopathy
Clear
Anterior Chamber Leucocoria
Rest details not
appreciated
Shallow, Whitish
membrane in ant
chamber, Blood
stained
Iris CPA, Whitish
membrane over iris
Pupil Details not seen
Pupillary Aperture Leucocoria blood tinge
seen over surface
Lens

19. Right Eye Left Eye
Fundus No glow No glow
Vision Patient doesn’t follow
light
Patient doesn’t follow
light
IOP Cannot be judged DF increased
Sac NROP NROP

20. Clinical Photographs

23. Provisional Diagnosis
 Both Eyes Leucocoria with Right Eye
Axial Proptosis with Exposure
Keratopathy with Left eye

24. Differential Diagnosis
 Retinoblastoma
 Orbital Cellulitis
 Congenital Cataract
 Persistent Hyperplastic Primary
Vitreous
 Retinopathy of Prematurity
 Ocular Toxocariasis

25. Investigations
 Routine Haematological Investigations
 Biochemical Investigations
 USG-B scan
 CT Brain with Orbit with axial and
coronal sections 2mm slice thickness
 MRI Brain with orbit
 Chest X-ray
 USG- Abdomen pelvis

26.  CSF cytology
 Bone marrow biopsy
 Technetium-99 bone scan
 PET- CT
 Aqueous LDH,
Phosphoglucoisomerase

28. THANK
YOU!!!