Features
• Leukocoria (white pupillary reflex) — most common presenting sign
• Strabismus
• Decreased vision
• Red, painful eye (less common)
Epidemiology
• Most common intraocular malignancy in children
• Usually diagnosed before age 5
Genetics
• RB1 gene mutation (chromosome 13q14)
• Heritable form (40%): bilateral, increased risk of secondary tumours (e.g., osteosarcoma)
Management
• Urgent ophthalmology referral — vision- and life-threatening
• Enucleation, focal therapy (laser, cryotherapy), chemotherapy
Features
• Most common primary intraocular tumour in adults
• Painless visual disturbances: blurred vision, visual field defects, photopsia
Risk Factors
• Light iris colour
• UV exposure
Signs
• Dome-shaped subretinal mass
• Orange pigment (lipofuscin)
• Serous retinal detachment possible
Management
• Plaque radiotherapy (brachytherapy)
• Enucleation for large tumours
Features
• Common in adults; usually bilateral
• Breast (women), lung (men)
• Visual loss, metamorphopsia (distorted vision), retinal detachment
Signs
• Creamy-white subretinal lesions
• Serous retinal detachment common
• Most common eyelid malignancy
• Pearly, rolled edges, central ulceration, telangiectasia
• Rarely metastasises, but local invasion can threaten the eye
• Less common
• More aggressive than BCC
• Potential for regional lymph node metastasis
• Rare but aggressive
• Often misdiagnosed as recurrent chalazion
• Commonly arises from meibomian glands
Extra Revision Pearls
• Leukocoria clue → retinoblastoma in children; also consider congenital cataract
• Bilateral intraocular metastases clue → breast cancer
• Orange lipofuscin clue → choroidal melanoma
• Rolled edge ulcer on eyelid clue → BCC
• Recurrent chalazion clue → sebaceous carcinoma
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
