Retinoblastoma: squinting or glowing in children, early sign of eye cancer

A child with eye deviation (squinting) can also be one of the early signs of retinoblastoma. [iStockphoto]

When Racheal had her baby girl in November last year, nothing prepared her for the numerous medical visits. While breastfeeding Amani, she noticed that the little one never made direct eye contact. And when she did, there was a white gleam in her eyes, especially most evenings.

She consulted an eye doctor, who confirmed her fears: Amani had retinoblastoma, a form of eye cancer common in children under the age of five.

She was shocked, but the ophthalmologist assured her that the diagnosis was made in a timely manner. Both eyes were saved. Today, Baby Amani is a happy and healthy 9 month old, hitting all his milestones, watching and singing along to his favorite cartoon, Cocomelon, and learning to walk while energetically exploring his surroundings.

Retinoblastoma is a cancer of one or both eyes that mainly affects children before their fifth birthday. The inner layer of the eye (retina) is affected, resulting in a white glow in the evening that resembles a cat’s eye in the dark.

A child with eye deviation (squinting) can also be one of the early signs of retinoblastoma. Other symptoms include swollen eyes, redness, and blurred vision. Retinoblastoma is a genetic mutation, and about five to six percent of patients have a positive family history, and those who survive it into adulthood are at high risk of passing it on to their children.

The good news is that seven out of ten children who are identified and treated early in Kenya make a full recovery. Hardly any child dies from retinoblastoma in developed countries, but in countries like Kenya, children are treated at very advanced stages, reducing the chances of a full recovery.

By the time a child presents to the hospital with the white glow, it often means the cancer is progressing and the only treatment to save the child is removal of the eye. If the cancer is in the eye, the child is considered cured. If the cancer has spread beyond the eye, chemotherapy and radiation therapy are recommended. Chemotherapy uses chemicals to kill cancer cells, while radiation therapy uses beams of energy.

Sometimes the cancer is detected when it is still small and the eye can still see. In such cases, treatment with chemotherapy, laser, or freezing may be used to preserve the eye and vision. Early diagnosis and treatment is therefore crucial and this cannot be achieved in a silo. It requires parents, guardians, and healthcare workers to have a higher index of suspicion when visiting children at wellness clinics.

Government should educate primary health care staff on the importance of prompt referral of a child with a white glow or squint. Although the vaccination maternal and child health booklet makes clear what health workers should look for in a child’s eyes when setting out for routine vaccination, it does not miss a great opportunity for early diagnosis.

This means that health workers in primary care settings need increased awareness to understand the importance of the white glow as an indication of immediate referral.

Eye cancer in children in Kenya can be treated at Kenyatta National Hospital, Moi Teaching and Referral Hospital in Eldoret, Kikuyu Eye Unit (Thogoto) and Lighthouse Eye Center (Mombasa). The treatment to save an eye in cancer is mainly offered in the national referral hospital KNH, where a specialized and dedicated team of medical professionals will make the treatment plan on a case-by-case basis.

– dr Kahaki Kimani, Consultant Ophthalmologist, is a Lecturer at the University of Nairobi.

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