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Endogenous endophthalmitis simulating retinoblastoma. The 1993 David and Mary Seslen Endowment Lecture
J A Shields1, C L Shields, R C Eagle
1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Insights
Endogenous endophthalmitis can mimic retinoblastoma in children. Careful clinical examination reveals signs of inflammation, aiding differentiation between these serious ocular conditions.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Infectious Diseases
Background:
- Retinoblastoma is a common intraocular malignancy in children.
- Endogenous endophthalmitis, an intraocular infection, can present with similar symptoms.
- Differentiating these conditions is crucial for appropriate management.
Observation:
- Six pediatric cases with suspected retinoblastoma were reviewed.
- Unusual forms of endogenous endophthalmitis were diagnosed.
- Clinical features suggesting infection over malignancy were investigated.
Findings:
- Diagnoses included various forms of endophthalmitis (e.g., bacterial, viral, fungal).
- Patients primarily presented with ocular findings, lacking severe systemic illness.
- Signs of concurrent or prior inflammation were more indicative of endophthalmitis.
Implications:
- Clinical examination provides key clues for distinguishing endophthalmitis from retinoblastoma.
- Early and accurate diagnosis is vital for preserving vision and life.
- This study highlights the importance of considering infectious etiologies in pediatric intraocular masses.
Background:
Among conditions that can simulate retinoblastoma, endogenous endophthalmitis is quite rare.
Methods:
Case records of six children with unusual forms of endogenous endophthalmitis, all of whom were referred to the authors because retinoblastoma was a strong diagnostic consideration, were reviewed. The clinical features that may help differentiate atypical endophthalmitis from retinoblastoma were investigated.
Results:
The final diagnosis in these cases included idiopathic subretinal abscess, streptococcal endophthalmitis, idiopathic retinovitreal abscess, cytomegalovirus endophthalmitis, Candida endophthalmitis, and meningococcal endophthalmitis. All of the affected children presented primarily with ocular findings without serious systemic infection. Although these conditions closely simulated retinoblastoma, they were more likely to have signs of concurrent or prior inflammation.
Conclusion:
Differentiation between infectious conditions and retinoblastoma can sometimes be difficult, but clues as to the diagnosis can be obtained from careful clinical examination.