What are the symptoms of retinoblastoma?

The symptoms of retinoblastoma are different at different stages. In the early stages, changes in the fundus will occur and gray-white tumor nodules will form on the surface of the iris. When it reaches the glaucoma stage, the patient will experience symptoms such as eye pain, headache, and vomiting.

1. Growth period in the eye

When the tumor starts to grow inside the eye, the external eye appears normal. Because the child is young and cannot report whether he or she has visual impairment, the disease is generally not easy to detect in the early stages. When the tumor proliferates and invades the vitreous body or approaches the lens, a yellow light reflex will appear in the pupil area. This is often discovered by parents due to visual impairment such as mydriasis, leukocoria, or strabismus. Fundus changes: round or oval, clearly bordered, single or multiple, white or yellow nodular protrusions with uneven surfaces, varying sizes, and new blood vessels or bleeding spots can be seen. Tumors originating from the inner nuclear layer and growing into the vitreous are called endophytic types, in which white mass-like turbidities of varying sizes can be seen in the vitreous; tumors originating from the outer nuclear layer and tending to grow into the choroid are called exophytic types, which often cause solid flat detachment of the retina without holes. Slit lamp examination may show tumor cell colonies in the anterior chamber, forming pseudohypopyon and posterior corneal deposits, and gray-white tumor nodules on the surface of the iris, which can provide some clinical basis for early diagnosis.

2. Glaucoma stage

As the tumor gradually grows and increases in size, the contents of the eye increase, causing intraocular pressure to rise, causing secondary glaucoma and symptoms such as eye pain, headache, nausea, vomiting, red eyes, etc. The wall of the eyeball of children is more elastic. Long-term high intraocular pressure can cause the wall to expand and the eyeball to swell, forming a special so-called "bull's eye" appearance, large cornea, corneal staphyloma, etc., so it should be differentiated from congenital glaucoma.

3. Extraocular stage

(1) The earliest thing that happens is that the tumor cells spread along the optic nerve into the skull. Due to the invasion of the tumor tissue, the optic nerve becomes thicker. If the bone of the optic foramen is destroyed, the optic foramen will expand. However, even if the optic foramen appears normal in size on X-rays, the possibility of retrobulbar and intracranial metastasis cannot be ruled out.

(2) The tumor penetrates the sclera and enters the orbit, causing the eyeball to protrude. It can also extend forward to cause corneal staphyloma or penetrate the cornea and grow outside the eyeball, and may even protrude outside the palpebral fissure and grow into a huge tumor.