Also known as a squint, strabismus can be the first sign of retinoblastoma. This is a misalignment of the eyes that may either turn in or out, up or down. Strabismus is often incorrectly referred to as “lazy eye”.
Strabismus is a common occurrence in babies younger than six months, and frequently resolves naturally. However, the baby’s eyes should be examined to ensure retinoblastoma or another serious eye condition is not the underlying cause. Delaying screening until after six months old may be devastating for a baby who does have retinoblastoma.
Leukocoria (cat’s eye reflex, white pupil)
A red, painful eye may be the first sign that something is wrong. Pain indicates a very advanced tumour that is a threat to life, and rapid specialist referral is essential.
A bulging eye (proptosis) is also a very serious indicator of advanced cancer, and the child should be urgently seen by an ophthalmologist.
Seek specialist ophthalmology care immediately if you notice any of the following:
A red, painful, bulging or ruptured eye
A swelling in the socket of a removed eye
The artificial eye becomes difficult to fit
Symptoms occur when the brain tumour compresses or invades local structures, or spreads to other parts of the brain.
Symptoms of pineal region tumours include:
severe headaches that wake the child and are relived by vomiting.
increased pain on leaning forward
persistent nausea and vomiting
inability to look upwards or fix gaze (the child may close the eyes excessively because of this).
irregular pupil shape
inability to judge distance
loss of consciousness
Symptoms of suprasellar and parasellar tumours may also include:
excessive thirst and drinking
precocious puberty (puberty that occurs earlier than is normal)
reduced visual acuity
a bulging eye
increased appetite and weight gain
inability to regulate temperature
low sodium levels (sodium is an electrolyte)
Remember that many of these symptoms can be caused by other less serious conditions. However, in children with a known or suspected constitutional RB1 mutation, unexplained symptoms should be investigated promptly.
If any of these symptoms occur and persist for more than a few days, we recommend you contact the ophthalmologist or oncologist who has been leading your child’s care. Primary doctors may not realize the significance of these symptoms.