Optical assistants and receptionists’ referral protocol for suspected retinoblastoma

16 May 2018

Around 50 babies and young children under six every year in the UK are diagnosed with a cancer of the eye called retinoblastoma. Many of these children end up losing an eye to save their life


It is essential to ensure all practice staff, especially optical assistants, receptionists and dispensing opticians, are aware of the most common signs of retinoblastoma. You might be the first or only point of contact for a worried parent and it is vital you give them the correct advice. The most common signs are: a white glow in the eye; a white reflection in a photo where a flash has been used; or a new squint). A child who has displayed any of these symptoms needs urgent assessment by a GP or an optometrist.

If a parent phones to make an appointment for a baby or young child, ask WHY. If they mention noticing a white ‘glow’ in the pupil of an eye, or a pale pupil reflex in a photo, or a new squint:

  • Tell the parent that the child must be examined urgently by an optometrist, ophthalmologist or GP to rule out a serious eye condition.
  • If your practice does not examine babies and small children, ensure the parents understand that urgent arrangements must be made for the child to be examined elsewhere (another optometrist or ophthalmologist who does examine young children, or their GP).

The main signs of retinoblastoma are:

  • A white glow in the pupil or a white reflection in the pupil in flash photographs
  • A new squint
  • A change in the colour of the iris
  • A deterioration in vision

Rarely, retinoblastoma may present as a red, sore or swollen eye without other signs of infection such as discharge. Any of these signs in isolation can indicate retinoblastoma.

If a parent continues to have concerns about their child’s eye, the child should be taken back to the GP / optometrist.

Remembering to ask WHY could save a child’s eye – or even their life.