Pediatric Oncology
Education Materials

Sign/Symptom

Significance/Additional Notes

Impaired visual acuity

• Most common presenting complaint.

• Usually becomes apparent after substantial disease progression - often during a routine school eye exam.

Painless Proptosis

• Proptosis is often painless and irreducible. 

• Tumor pushes the globe forward.

• Often the first sign of an intra-orbital mass.

Visual field defects

• Suggests the disease has an infiltrative nature.

• Defects are variable, may be central, or eccentric field cuts.

Nystagmus

• Rapid and short oscillations when scanning or searching.

• Suggests chiasmatic involvement.

Strabismus

• Deviation in alignment of one eye relative to the other.

• Results in the inability to focus on objects.

Hypothalamic dysfunction

• Precocious puberty relatively common.

• Often due invasion of the third ventricle. 

• May result in hydrocephalus and papilledema. 

• Only becomes apparent after substantial tumor growth.

• Emaciation, failure to thrive, amnesia, abnormal eye positions.

• Observed in infants and young children.

• Blurring of the optic disc and loss of central vision. 

• Suggests an intraorbital tumor.

Tumor location

Associated symptoms

Intraorbital

• Painless proptosis
• Papillitis

Optic nerve

• Unilateral visual loss

Optic chiasm

• Nystagmus
• Bilateral field cuts
• Papilledema

Optic tract

• Bilateral field cuts

Hypothalamus

• Precocious puberty
• Diencephalic Syndrome

Ventricular system/ Foramen of Munro

• Hydrocephalus and papilledema