Page 137 - NAME OF CONDITION: REFRACTIVE ERRORS

E. Extraocular tumor, International Staging, Stage IIIA
Refer to retinoblastoma treatment center

F. Regional Lymph Node Metastasis, International Staging, Stage IIIB
Refer to retinoblastoma treatment center

G. Hematogenous or Central Nervous System Metastasis, International Staging,
Stage IV
Refer to retinoblastoma treatment center

Standard Operating Procedure

a. In-Patient :Admit patients for enucleation
b. Out Patient: All older children who can cooperate for examination
c. Day Care: All children undergoing examination under anesthesia

c) Referral criteria:

a) Intraocular tumor, International Classification Group A to C, Unilateral or
Bilateral
b) Intraocular tumor, International Classification Group D, Unilateral or Bilateral
c) High risk factors on histopathology, International Staging, Stage II
d) Extraocular tumor, International Staging, Stage IIIA
e) Regional Lymph Node Metastasis, International Staging, Stage IIIB

f) Hematogenous or Central Nervous System Metastasis, International Staging,
Stage IV

Situation 2: At Super Specialty Facility in Metro location where
higher-end technology is available

a) Clinical Diagnosis:

A good history eliciting specific symptoms and also a family history of retinoblastoma

are essential. Leucocoria is the most common presenting feature of retinoblastoma,
followed by strabismus, painful blind eye and loss of vision. The clinical presentation
of retinoblastoma depends on the stage of the disease. Early lesions are likely to be
missed, unless an indirect ophthalmoscopy is performed. The tumor appears as a
translucent or white fluffy retinal mass. The child may present with strabismus if the
tumor involves the macula or with reduced visual acuity.

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