Symptoms of Retinoblastoma

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Retinoblastoma is a tumor of the light-sensitive retina at the back of the eye that typically occurs in young children under the age of 3.

A parent may notice something is amiss when they take a photograph with a flash and, instead of appearing red in the photo as it typically would, the child's pupil in one or both eyes looks white or pink.

Frequent Symptoms of Retinoblastoma - Illustration by Julie Bang

Verywell / Julie Bang

Other signs range from eye pain and vision problems to lazy eye and pupil issues, as well as bleeding or bulging, in some cases. Even the shade of the colored part of the eye may be affected. It is possible to cure this type of tumor in as many as 9 out of 10 children.

In about two-thirds of cases, just one eye is affected. The other eye may, however, become affected later on. But in some rare cases, retinoblastoma tumors develop in both eyes at the same time.

This article will discuss the common and rare signs and symptoms that can help you detect this rare type of eye tumor early. It will also cover complications of retinoblastoma and when to see a doctor.

Frequent Symptoms

There are myriad possible signs of retinoblastoma that may point to the condition. Some of the most common signs to look for include:

  • Cat's eye reflex (leukocoria): Instead of a normal red reflex under flashbulb conditions, seeing the red vessels of the eye, you notice a white pupil reflex. This occurs in about 60% of retinoblastoma cases. It doesn't always indicate retinoblastoma, just that it should be ruled out by an ophthalmologist (eye doctor).
  • Crossed eye (strabismus) or lazy eye (amblyopia), in which one eye appears to be looking toward the ear or the nose: These conditions usually are caused by something other than retinoblastoma.
  • Inflamed red eyes, usually without pain
  • Decreased vision
  • Eye bulging
  • Side-to-side movements of the eyes, known as nystagmus
  • Different left and right pupil sizes
  • Different eye colors in the same person (heterochromia)
  • Uveitis: This is inflammation in the eye's middle layer

Rare Symptoms

Some children with retinoblastoma may also show other unusual signs. What's known as a vitreous hemorrhage, with blood leaking near the jelly-like fluid that fills the eye (the vitreous), can occur in some infants. This can result in vision loss.

In some cases, there are also occurrences of what's known as "hyphema," in which blood collects between the colored iris and the clear dome-shaped covering known as the cornea. With blood covering some or all of the area, this is not only painful, but it can cause partial or complete blockage of vision.

In less than 5% of cases, children will not only develop retinoblastoma of the eye, but also of the brain, called a trilateral retinoblastoma. In most cases, the brain tumor involves the pineal gland, which is in the brain and helps regulate sleep and wake cycles.

While in most cases the retinoblastoma is confined to the eye, on rare occasions it can spread to other areas, including the lungs, skeleton, lymphatic system, and nervous system. This can cause symptoms such as:

  • Weight loss for no apparent reason
  • Headaches
  • Nausea/vomiting
  • Nervous system damage

Complications/Subgroup Indications

In addition to being alert for potential signs of retinoblastoma, it's important to know about treatments and how they can help, as well as what to do if the tumor spreads.

There is a variety of complications related to retinoblastoma treatment to have on the radar. These include:

  • The formation of a cataract, in which the lens becomes cloudy, can occur as a result of radiation treatment. However, the lens can then be removed and vision restored. Cataract removal also does not seem to spur new retinoblastoma formation.
  • Retinal detachment (the retina separates from the back of the eye)
  • Loss of vision
  • Surgical infection or bleeding
  • Chemotherapy reactions, such as nausea, diarrhea, bruising, bleeding, and tiredness
  • Spread of the retinoblastoma
  • New cancers arising

If the retinoblastoma continues to grow, tumors may form in other parts of the eye besides the retina. These can block the drainage channels in the eye, potentially causing a rise in eye pressure. This leads to glaucoma, in which pressure damages the optic nerve, which can cause vision loss and pain.

Retinoblastoma almost never occurs in adults. There are only around 30 cases recorded worldwide. Those extremely rare cases have been reported in people between the ages of 20 and 74. Symptoms that have been found in this group include:

  • Vision loss, partial or complete
  • Whitish mass
  • Eye bulging

When to See a Healthcare Provider

One of the keys to preserving vision with retinoblastoma is to catch it as early as possible. Be on the lookout for the following:

  • Any changes in vision
  • Anything that looks different about the eye, inside or out
  • Any differences in how the eye moves

If you notice anything that's slightly amiss with your child's vision or in how the eye looks, get this promptly checked out by a healthcare provider.

Summary

Cases of retinoblastoma can occur in children and are often noticed by a parent who is alert for the signs and symptoms. A first sign may be detected in a photograph taken with a flash, which would show a white glint instead of the typical appearance of red eyes.

Having a wayward lazy eye may also indicate retinoblastoma, although it could be the result of muscle weakness instead. Report to a physician any vision changes, movement issues, eye bulging, or changes in eye color or pupil size.

A Word From Verywell

Being alert for signs of retinoblastoma can potentially preserve a child's sight. While this tumor is not common and any symptoms are likely due to something less serious, if your child indeed has retinoblastoma, treating it as soon as possible can greatly improve your child's outcome.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. National Health Service. Retinoblastoma (eye cancer in children).

  3. National Organization for Rare Disorders. Retinoblastoma.

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By Maxine Lipner
Maxine Lipner is a long-time health and medical writer with over 30 years of experience covering ophthalmology, oncology, and general health and wellness.