Ophthalmic Education:

Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students: Chapter XI: Intraocular Tumors

On this page:

• Retinoblastoma
  
  
• Uveal melanoma
  
  
• Other intraocular tumors
  
  
• Clinical Competencies

Educational Goal: 

Students should understand that malignancy may affect the eye and adnexa and recognize the signs and symptoms of childhood retinoblastoma.

A. Retinoblastoma.*

(REF. 3 Case 27, Leukocoria/Retinoblastoma, p.54) (REF. 22 Fig. H27, H28, H29)

1. Knudson’s two-hit hypothesis.***

2. Genetics.***

a. 13q14 deletion.***

b. Heritable vs. sporadic.***

3. Clinical presentation.*  

a. Leukocoria.*

b. Strabismus.*

4. Treatment.***

a. Chemotherapy and radiation therapy.***

b. Surgical (enucleation).***

5. Differential diagnosis.***

a. Retinopathy of Prematurity (ROP).*** (REF. 10, Stages of retinopathy of prematurity, Fig XXIV-2-XXIV-6 p.304) (REF. 22 Fig. H32, H33, H34, H35, H36)

b. Coats’ disease.*** (REF. 22 Fig. K31, K32)

c. Persistent Hyperplastic Primary Vitreous.*** (REF. 22 Fig. H39, H40)

B. Uveal melanoma.**

(REF. 3 Case 7, Malignant Choroidal Melanoma, p. 14)

1. Most common primary intraocular malignancy.**

2. Variants.***

a. Iris.***

b. Ciliary body.***

c. Choroidal.*** (REF. 22 Fig. K25, K26)

3. Clinical presentation.*  

a. Asymptomatic vs. symptomatic.*  

b. Pigmented vs. amelanotic.***

4. Prognosis.***

a. Size.***

b. Cell type.***

5. Treatment.***            

a. Non-surgical.***

b. Surgical (enucleation).***

6. Differential diagnosis.***

a. Choroidal nevus.***

b. Metastasis to eye.***

c. Retinal detachment.***

C. Other intraocular tumors.***

1. Lymphoma - primary large cell lymphoma vs. systemic lymphoma.***            

2. Metastasis - carcinomas in adults.*** (REF. 2F Slide 35, 36)

3. Leukemia infiltration of optic nerve.*** (REF. 2F Slide 29)

Clinical Competencies

Students should:

• Assess  red reflex with flashlight/penlight and direct ophthalmoscope.*  
• Assess ocular alignment with Hirschberg test.*  
• Obtain history for risk factors for retinoblastoma.*  
• Recognize retinal detachment/intraocular tumor on fundus exam of adult.***

* Basic Level: Necessary in the education of medical students worldwide.

** Standard Level: A higher level of ophthalmic understanding than the basic curriculum of most international medical students.

*** Advanced Level: Advanced cognitive and clinical skills more appropriate for students who seek further training in ophthalmology, which may be covered in an ophthalmology elective in medical school.

(Also see: More on Educational Priorities)

Next: XII. Refraction and Contact Lens

Also see:

• Table of Contents of the "Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students"
  
  
• Education of Medical Students in Ophthalmology
  
  
• Resources for Ophthalmic Education of Medical Students