Paediatric
Retinoblastoma
Also known as: retinoblastoma, white pupil child, leukocoria child, cat's eye reflex, white glow in photos, RB1, intraocular tumour child, squint under 3
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
The commonest primary intraocular malignancy of childhood, reported at approximately one in 20,000 children. Around 90% present before age 3 and 95% before age 5; median age at diagnosis is about 12 months for bilateral disease and about 24 months for unilateral. It is life-threatening as well as sight-threatening, and it is the reason an abnormal red reflex in a child is never a routine finding.
Recognition
Symptoms: what patients report
- Parent-reported white glow or 'cat's eye' appearance of the pupil, often first noticed in flash photographs.
- A new or noticed eye turn.
- Usually no pain and no redness in early disease — the child is systemically well.
- Red, painful eye or a protruding eye indicates ADVANCED disease.
Signs: what the examination shows
- Leukocoria — the presenting sign in approximately 60-80% of cases.
- Strabismus — the presenting sign in approximately 20-30% of cases.
- Absent, dull or asymmetric red reflex on Bruckner testing.
- A white or cream retinal mass with or without calcification on fundoscopy, where the fundus can be seen.
- Advanced disease: red eye, pain, raised intraocular pressure, proptosis, orbital involvement.
What OptoGuide™ covers for retinoblastoma
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Retinoblastoma — StatPearls
- RANZCO — Paediatric Referral Guidelines (April 2025)
- Optometry Australia — Paediatric Eye Health and Vision Care clinical practice guide (Aug 2016)
- Lesions Simulating Retinoblastoma (Pseudoretinoblastoma) in 604 Cases: Results Based on Age at Presentation. Shields CL, Schoenberg E, Kocher K, et al. Ophthalmology. 2013;120(2):311-6.
- ACR Appropriateness Criteria® Orbital Imaging and Vision Loss-Child. Expert Panel on Pediatric Imaging, Maheshwari M, Ho ML, et al. Journal of the American College of Radiology : JACR. 2024;21(6S):S219-S236.
- Retinoblastoma and beyond: pediatric orbital mass lesions. Rumboldt Z, Dodig D, Galluzzi P, et al. Neuroradiology. 2025;67(2):469-492.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual.