both eye retinoblastoma

1. By:-
Dr Sudhanshu Shekhar
1st yr PGT
Dept. of ophthalmology, MGMMC

2.  A 2yr old female child named anu Priya was brought by parents to eye opd with
chief complaints of:
 White reflex in both eye since birth
 Poor vision in B/E since birth
 Forward protrusion of Rt eye since 15days
 redness, chemosis and watering from both eye

3.  History narrated by parents
 Parents had noticed white reflex in BE since birth
 Gradually it increased in size.
 Patient had no fixation of eyes
 Patient had no useful vision
 h/o repeated fall
 15 days back she developed forward bulging of right eye associated with pain, redness,
 chemosis, watering.
 It increased progressively to reach present state.
 Associated with malaise, lethargic, behaviour

4.  No h/o fever
 No h/o squint in either eye
 No h/o previous attacks of pain, redness and watering
 No h/o NICU admission, oxygen therapy.
 No h/o pets like dogs or cats
 No h/o convulsions.

5.  No h/o hospitalisation in past
 No h/o TB, bronchial asthma
 No h/o major surgery in past

6.  No h/o similar illness in siblings
 No h/o eye lost in other family member
father mother
8yr female 6yr male
2yr female
(patient)

7.  FTND At home
 Baby cried at birth
 Birth weight 2.5kg
 No h/o NICU admission, no h/o O2 therapy
 Vaccination: Well immunised till date

8.  Sleep- disturbed
 Appetite- reduced, weaning started
 Bowel/bladder habits- altered

9.  Pt is conscious, irritable ,un-cooperative
 Pulse- 104/min
 Bp- 100/70mmhg
 R.R- 19/min
 No h/o pallor, icterus, cyanosis, clubbing
 No h/o Lymphadenopathy (cervical or pre-auricular)
 No h/o pedal oedema

11.  Pt is highly uncooperative
 Head posture normal
Right eye Left eye
vision Pt doesn’t follow light Pt doesn’t follow light
Eye brows normal normal
lids oedema normal
eyelashes matted normal
conjunctiva Congestion, severe
chemosis with
prominent conjunctival
blood vessels
Circumcorneal
congestion
cornea oedematous clear

12. Right eye Left eye
Ant chamber
Proptosed eye ball
Details not
appreciated
Shallow
iris Normal pattern
pupil Round dilated , non-reactive
Leucocoria
lens
fundus Not visible No glow(cat eye reflex)
IOP Cant be judged Increased(digitally)

13. B-SCAN
RIGHT EYE

14. B-SCAN
LEFT EYE

15.  Routine blood investigation(CBC, RBS, DLC)
 B-scan both eye
 CT brain with orbit
 Chest x-ray
 USG abdomen & pelvic
 CSF cytology
 Bone marrow biopsy
 PET-CT
 Technetium 99 bone scan

16.  Rt eye retinoblastoma advanced stage with orbital extension with
proptosis of eye ball
 Lt eye retinoblastoma endophytic growth pattern

17.  Referred to higher centre.

18. 