The Eyes Have It

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Cat's eye reflex
The reflection in the boy's left pupil is white because a white mass is abutting the back of the lens.

This cat's eye reflex (leukocoria) can be caused by many conditions, the most serious being retinoblastoma, a life-threatening intraocular tumor of early childhood.

The most common intraocular tumor of childhood, it is diagnosed once in every 20,000 births. In 1/3 of cases, the retinoblastoma involves both eyes. Most cases are diagnosed within the first two years of life. The earlier, the better, in terms of saving sight and life.

The tumor arises from primitive neural retina and usually grows forward into the vitreous cavity. About 60% of cases are detected when they cause the cat's eye reflex, 25% when a child's eyes go out of alignment (strabismus), and 15% when they cause a child to fail routine vision screening or to develop a red eye or proptosis.

Treatment consists of removal of the eye (enucleation) or, in special situations, radiation and chemotherapy, which may preserve sight. Aggregate five-year survival is 92%, but the prognosis drops sharply if the tumor is large.

What to do?
Refer urgently any youngster who has a cat's eye reflex or who lacks a clear red reflex obtained by shining the ophthalmoscope light into the pupil from a distance of about one foot.

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The Eyes Have It
An interactive teaching and assessment program on vision care
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Originally created by Jonathan Trobe, M.D., University of Michigan Kellogg Eye Center
© 2009 The Regents of the University of Michigan

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