Eye cancer in children symptoms and early detection methods for children

Eye cancer in children, also known as retinoblastoma, is a rare but very serious condition if not detected early. A child with this condition may show subtle signs that parents can easily overlook, such as a white reflection in the pupil, vision problems, or eye misalignment (strabismus).Early detection of retinoblastoma plays a major role in successful treatment and in preserving the child’s vision.In this Dalily Medical article, we will discuss the symptoms of eye cancer in children, methods of early detection, and the most important steps for prevention and treatment, explained in a simple and clear way for every parent.

Childhood Eye Cancer (Retinoblastoma and Other Tumors)

What is Eye Cancer in Children?

Eye cancer in children is most commonly retinoblastoma, a tumor that develops in the retina and affects the child’s ability to see.

Is Retinoblastoma Hereditary?

In some cases, retinoblastoma can be hereditary. That’s why genetic screening for newborns with a family history is important for early detection.

Does the Child Need Follow-up After Treatment?

Yes, follow-up is essential to monitor:

Eye growth
Visual function
Early detection of recurrence

Can Vision Be Preserved After Treatment?

It depends on the tumor’s size, location, and time of diagnosis.

In early stages, vision can often be preserved or significantly improved.

When Should Parents Visit an Eye Doctor Immediately?

If a white or gray pupil appears
If the child suddenly develops strabismus (eye misalignment)
If there are signs of vision loss or abnormal eye movements

Is Eye Cancer in Children Common?

No, it is relatively rare, affecting about 1 in every 15,000–20,000 children worldwide.

Can It Affect Both Eyes?

Yes, hereditary cases can affect one or both eyes.

Can Childhood Eye Cancer Be Prevented?

Complete prevention is not possible, but early detection, especially in children with a family history, improves treatment outcomes.

Is the Tumor Always Malignant?

Most retinoblastomas are malignant, but with early treatment, it can be controlled and prevented from spreading.

How Long Does Treatment Usually Take?

Treatment duration depends on the tumor’s size and spread. It may range from a few sessions to several months in advanced cases.

Does Every Child Need Eye Surgery?

Not always. Small tumors can sometimes be treated with:

Localized chemotherapy
Cryotherapy (freezing therapy)
Laser photocoagulation

Large tumors often require surgical intervention.

Is Treatment Painful for the Child?

Most procedures are performed under general anesthesia, so the child does not feel pain during treatment. Post-operative discomfort can be managed with medication.

Can the Tumor Recur After Treatment?

Yes, which is why regular follow-ups are crucial for early detection of recurrence.

Does the Child Need Vision Correction After Treatment?

Often yes. Children may need glasses, contact lenses, or vision therapy exercises to improve focus and clarity.

Are There Long-Term Side Effects of Chemotherapy or Radiation?

Yes, some treatments may affect eye growth or vision development. Careful, ongoing monitoring helps reduce long-term complications.

Types of Eye Tumors in Children

Retinoblastoma
- Most common in children.
- Origin: retina (light-sensitive layer).
- Symptoms: white pupil (leukocoria), strabismus, vision loss.
Uveal Melanoma (very rare)
- Origin: middle layer of the eye (uvea).
- Symptoms: eye color changes, blurred vision, eye pain.
Vascular Tumors (e.g., Retinal Hemangioblastoma)
- Benign tumors in retina or cornea.
- Symptoms: abnormal blood vessels, eye redness, partial vision loss.
Lacrimal Gland Tumors (rare)
- Appears as swelling above the eye.
- Symptoms: eye bulging, mild pain, shape changes.
Iris or Choroidal Melanoma (rare)
- Symptoms: iris color changes, strabismus, partial vision loss.
Other Embryonal Tumors (e.g., Medulloepithelioma)
- Usually before age 5.
- Symptoms: eye swelling, strabismus, redness, occasional pain.

Stages of Eye Tumors in Children

Early Stage
- Small, localized tumor in the retina.
- Symptoms: occasional white pupil in photos, mild vision loss.
Localized Advanced Stage
- Tumor grows and presses surrounding tissues.
- Symptoms: clear strabismus, mild swelling/redness, poor vision.
Advanced Intraocular Stage
- Tumor fills most of the eye.
- Symptoms: significant vision loss, constant white pupil, eye pain.
- Urgent medical intervention is required.
Extraocular Spread
- Tumor extends beyond the eye to the lacrimal gland or nerves.
- Symptoms: severe swelling, constant pain, complete vision loss.
- Treatment: surgery, chemotherapy, or radiation to save the child’s life.

Risks of Childhood Eye Tumors

Vision loss (partial or complete)
Strabismus due to reduced vision in one eye
Intraocular spread (tumor filling the eye)
Extraocular spread (to nerves, glands, or brain)
Visual development problems (poor eye coordination)
Treatment complications (infection, glaucoma, structural changes)
Psychological impact (low self-esteem, social challenges)

Diagnosis of Eye Cancer in Children

Clinical Eye Exam
- Checking for white/gray pupil, strabismus, or light sensitivity.
- Exam with magnifying lens or ophthalmoscope.
Examination Under Anesthesia (EUA)
- For infants and small children.
- Allows detailed assessment of retina and optic nerve.
Imaging Tests
- CT Scan: measures tumor size and spread.
- MRI: evaluates tumor extension inside/outside the eye.
- Fluorescein Angiography: highlights abnormal blood vessels.
Ocular Ultrasound
- Safe, painless, measures tumor size and density.
Genetic or Blood Tests
- For children with family history.
- Detects genetic mutations linked to retinoblastoma.
Biopsy (in rare cases)
- Usually avoided in retinoblastoma to prevent tumor spread.
- Considered only after thorough medical evaluation.

Tips for Parents

Seek medical care early if you notice white pupil, strabismus, or vision problems.
Commit to regular follow-ups to track tumor response to treatment.
Stick to the treatment plan (surgery, chemo, or radiation) as prescribed.
Support the child emotionally to reduce the psychological impact of treatment and vision problems.

Psychological Support for the Child

Emotional impact: Tumors and treatments can cause fear or anxiety.
Communication: Explain the condition simply and encourage the child to express their feelings.
Daily activities: Play and routine activities help the child adapt better.

Protecting the Affected Eye

Avoid trauma or accidental injury.
Use protective glasses if recommended by the doctor.

Supporting Nutrition and General Health

Healthy nutrition supports the immune system.
Ensure regular sleep patterns and age-appropriate physical activity.

Preventing Infections

Wash hands before touching the eyes or after play.
Gently clean the face and eyes to reduce irritation or infection risk.

Continuous Communication With the Medical Team

Ask about any changes in tumor size or new symptoms.
Always consult the medical team about treatment concerns or side effects.

Medical Treatment for Eye Cancer in Children

Chemotherapy

Description: Strong medicines used to destroy cancer cells.
Methods of administration:
- Intravenous (IV)
- Direct injection into the eye’s artery (Intra-arterial)
- Injection into the vitreous cavity (Intravitreal)
Goals: Shrink the tumor before surgery or radiation, prevent spread, and preserve the eye and vision.

Targeted Therapy

Medications that specifically attack tumor cells without major harm to the rest of the body.
Used based on the tumor’s genetic profile.

Supportive Medications

Anti-nausea drugs to ease chemotherapy side effects.
Medications to stimulate blood cell production.
Antibiotics or antifungals to prevent infections when immunity is weak.

Surgical Treatment for Childhood Eye Tumors

Enucleation (Complete Eye Removal)

Description: Removing the entire eye when it cannot be saved or when the tumor is very large.
After surgery: A prosthetic eye can be implanted for cosmetic purposes, with close follow-up to prevent recurrence.

Local Tumor Resection (Focal Surgery)

Removing only the tumor while preserving as much of the eye as possible.
Best for: Small or localized tumors.
Advantage: Partial vision preservation, less cosmetic impact.

Laser or Cryotherapy-Assisted Surgery

Using laser or freezing techniques to destroy tumor cells before or after partial resection.
Goal: Reduce tumor size and prevent local spread.

Partial Lens or Cornea Removal (if needed)

If the tumor is close to the lens or cornea, part of it may be removed.
Vision can be restored with artificial lenses or prescription glasses.

Summary Table of Treatment Options for Childhood Eye Tumors

Treatment	Description	Method	When Used	Advantages	Possible Complications
Chemotherapy	Anti-cancer drugs to kill or shrink tumor cells	IV, intra-arterial, intravitreal	Multiple or large tumors, pre-surgery shrinkage	May control tumor without eye removal	Hair loss, fatigue, low white cells, vomiting, temporary liver/kidney impact
Radiotherapy	High-energy radiation to destroy cancer cells	External beam or brachytherapy (plaque)	Tumors resistant to chemo, or after surgery if cells remain	Preserves healthy tissue, reduces tumor size	Eye inflammation, slowed eye growth, rare vision impact
Cryotherapy	Freezing tumor cells with very low temperatures	Cold probe applied repeatedly to tumor	Small/medium tumors, especially at retinal edge	High precision, eye preservation, minimally invasive, repeatable	Temporary irritation, minor bleeding, temporary vision effects
Photocoagulation (Laser Therapy)	Laser heats and destroys tumor or its blood supply	Focused laser beam under anesthesia	Small/medium tumors on retinal surface, often with chemo	High accuracy, eye preservation, minimally invasive, repeatable	Partial vision loss in treated area, temporary redness, mild scarring risk

Surgical Failure in Childhood Eye Tumor Treatment

Even with the best surgeons and technology, sometimes surgery does not fully remove the tumor or preserve vision. Causes include:

Tumor size or location: Large tumors or those close to the optic nerve are harder to control.
Late diagnosis: Early detection greatly improves outcomes; advanced tumors have higher failure rates.
Poor response to chemo or radiation: Some tumors do not shrink enough for effective removal.
Surgical complications: Severe bleeding, infection, or eye damage may affect success.
Recurrence (Relapse): Tumor may return if cancer cells remain.

Signs of Surgical Failure

Persistent white pupil or eye color changes
Continued vision loss after recovery
Tumor growth or spread

Next Steps After Failure

Detailed evaluation by an eye cancer specialist
Retreatment options: second surgery, chemotherapy, radiation, laser, or cryotherapy
Strict follow-up for early detection of recurrence
Psychological support for the child and family to manage fear and stress