A 2-year-old is suspected of having retinoblastoma. The nurse recognizes which sign as being most characteristic of this disease?

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11ecbb05_caf7_a38b_b433_d1b07e3c6712_MD0009_00 Retinoblastoma, a unilateral or bilateral retinal tumor, is the most common childhood intraocular malignancy. It is typically diagnosed in children under age 2 and is usually first recognized when parents report a white "glow" of the pupil (leukocoria). Light reflecting off the tumor will cause the pupil to appear white instead of displaying the usual red reflex (Option A). Parents may even accidentally visualize leukocoria when taking a photograph of the child using a flash. Strabismus (misalignment of the eyes) is the second most common sign; visual impairment is a late sign indicative of advanced disease. Treatment depends on severity and may include radiation therapy or enucleation (removal of the eye) and fitting for prosthesis. Siblings should undergo regular ocular screening, as some forms of retinoblastoma are hereditary. (Option B) A fixed and mid-dilated pupil is seen in acute glaucoma. (Option C) Ptosis is drooping of the upper eyelid often associated with injury of the oculomotor nerve (cranial nerve III). Ptosis is also characteristic for myasthenia gravis. (Option D) Bacterial conjunctivitis causes eyelid swelling, a red conjunctiva, eye discomfort, and purulent eye discharge. Educational objective: Retinoblastoma is a malignancy of the eye typically diagnosed in children under age 2. The pupil will reflect a white color, and the child will not have the normal red eye reflex. Treatment may include radiation therapy or enucleation (removal of the eye).

A 2-Year-Old Is Suspected of Having Retinoblastoma