2. Why worry about strabismus?

3. [1,8] Vitreous Hemorrhage (dark reflex) Hypopyon (layering of WBCs in anterior chamber)

4. Initial Presentation Most (75%) PARENTS detect abnormality http://shainazhope.com/

5. Retinoblastoma Autosomal dominant (RB1) with incomplete penetrance Increased risk other cancers – Only 5-10% of cases have family history

6. Retinoblastoma Age – 90% younger than 5 years at diagnosis – Average of 18 months – Rare cases in adults [1]

7. Morbidity/ Mortality 5 year survival 93% If untreated: Metastatic spread within 6 months – 50% 1yr survival With early detection, among most curable childhood cancer Leukocoria is actually a late finding – Ocular survival 9% at 5 years

8. Red Reflex http://www.daisyseyecancerfund.org

10. [9]

12. Red Reflex Screens all aspects of optical pathway – Tear film, cornea, aqueous and vitreous humor, iris, lens, retina. – Over 30 Diseases: Cataracts, glaucoma, retinoblastoma, systemic disease [3].

13. White Reflex “White Pupil” tapetum lucidum "bright tapestry"

14. White Reflex

15. PCP first noted presenting signs in only 5% Delayed PCP referral 21% (3.75 months) – PCP reassured parents of normalcy or made wrong diagnosis – False reassurance with normal red reflex

16. [11]

17. AAP Policy (Dec 2008) Document Red Reflex: – In newborn nursery – ALL routine health supervision visits Previous Recs: within 2months; 6 months; 1,3,5,10yrs Refer to ophtho: – All high risk patients Fam Hx: RB, infantile cataracts, retinal dysplasia, glaucoma – Based on parental observation alone – Abnormal red reflex (urgent) – Contact ophthalmologist directly – Document confirmation of proper followup [3]

18. What’s your Dx Retinoblastoma

19. Pseudostrabismus Strabismus

20. www.kidsretina.blogspot.com Pediatric retina blog Persistent Fetal Vasculature

21. Neuroblastoma with “Raccoon Eyes”

22. Congenital Cataracts

23. Congenital Glaucoma

24. Normal Retina

25. Take Home Points Screen in the nursery and at every checkup! Take parental concerns seriously and refer! Do not trust a normal red reflex if concerns are present. Call ophthalmologist directly, especially if abnormal exam. Close followup of high risk patients.