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Treatments for Retinoblastoma
Treatment list for Retinoblastoma:
The list of treatments mentioned in various sources for Retinoblastoma includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
- Radiotherapy
- Surgery
- Blocking the tumor's blood supply
- Surgical eye removal
- Genetic counselling - for families wanting other children.
Treatments of Retinoblastoma: Online Medical Books
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Red Eye:
Treatment
(In a Page: Signs and Symptoms)
- Ophthalmologic referral for HSV/herpes zoster keratitis or conjunctivitis, acute angle-closure glaucoma, scleritis, corneal ulcer, iritis, penetrating foreign bodies
- Avoid treating patients with steroid eyedrops without ophthalmologic consultation
- Conjunctivitis
–Allergic: Avoid offending agents, cold compresses to eyes, NSAIDs, ocular decongestants, antihistamines
–Viral: Self-limited, good hygiene to avoid spread
–Bacterial: Antibiotic eye drops; avoid neomycin, because allergic reactions are common
- Subconjunctival hemorrhage: Reassurance, cool compresses, clears spontaneously in 1–2 weeks
- Chemical eye injury: Immediate copious irrigation with normal saline for at least 30 minutes
- Preventative measures include proper hygiene and daily cleaning of contact lenses, proper hand-washing techniques before all contact with eyes, eye protection in occupations entailing possible ocular injury
Scleral Injection (Red Eye):
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Intense topical antibiotics for corneal ulcers
- Topical antibiotics for bacterial conjunctivitis (sulfa, fluoroquinolones; avoid gentamicin)
- Consider systemic ceftriaxone if suspect Gonococcus
- Tears, cool compresses, topical and oral antihistamines for allergic conjunctivitis
- Frequent handwashing for viral conjunctivitis
- Oral doxycycline and treatment of partners for chlamydia
- NSAIDs for epi/scleritis
- Oral doxycycline, topical Metrogel, warm compresses for rosacea, chalazia, and blepharitis
- Massage of inner canthus, hot compresses, oral and topical antibiotics for canaliculitis and dacrocystitis
- Check intraocular pressure if suspect angle closure glaucoma (pressure typically over 40 mmHg)
- Frequent lubrication for dry eye
Eye Discharge:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Blocked tear duct: Supportive care with massage and warm compresses; surgical probe or stent may be indicated if stenosis persists beyond 9 months of age
- Allergic conjunctivitis: Intraocular anti-inflammatory agents, antihistamines, or mast cell stabilizers
- Viral conjunctivitis: Supportive care for most routine viral infections; herpetic lesions should be referred to an ophthalmologist and must be treated with systemic acyclovir and intraocular steroids
-
Bacterial conjunctivitis: Usual pathogens are susceptible to polysporin/trimethoprim, may also be treated with quinolones; newborn STD pathogens must be treated systemically
- Foreign body: Removal may require referral to an ophthalmologist
- Corneal abrasion: Routine antibiotics and patching are no longer recommended, but may be used in more severe cases
Eye pain:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient's eye pain results from a chemical burn, remove contact lenses, if present, and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to reduce intraocular pressure (IOP). If drug treatment doesn't reduce IOP, the patient will need laser iridotomy or surgical peripheral iridectomy to save his vision.
Malignant spinal neoplasms:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of spinal cord tumors generally includes decompression or radiation. Laminectomy is indicated for primary tumors that produce spinal cord or cauda equina compression; it isn't usually indicated for metastatic tumors. If the tumor is slowly progressive or if it's treated before the cord degenerates from compression, symptoms are likely to disappear, and complete restoration of function is possible. In a patient with metastatic carcinoma or lymphoma who suddenly experiences complete transverse myelitis with spinal shock, functional improvement is unlikely, even with treatment, and his outlook is ominous. If the patient has incomplete paraplegia of rapid onset, emergency surgical decompression may save cord function. Steroid therapy with dexamethasone minimizes cord edema and temporarily relieves symptoms until surgery can be performed. Partial removal of intramedullary gliomas, followed by radiation, may alleviate symptoms for a short time. Metastatic extradural tumors can be controlled with radiation, analgesics and, in the case of hormone-mediated tumors (breast and prostate), appropriate hormone therapy. Transcutaneous electrical nerve stimulation (TENS) may control radicular pain from spinal cord tumors and is a useful alternative to opioid analgesics. In TENS, an electrical charge is applied to the skin to stimulate large-diameter nerve fibers and thereby inhibit transmission of pain impulses through small-diameter nerve fibers. Chemotherapy generally hasn't proven effective against most spinal tumors, but may be recommended in some cases.
Eye pain [Ophthalmalgia]:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s eye pain results from a chemical burn, remove contact lenses (if present) and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to decrease intraocular pressure (IOP). If drug treatment doesn’t reduce IOP, the patient will need laser iridotomy or surgical peripheral iridectomy to save his vision.
Eye discharge:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Inform patients with bacterial or viral conjunctivitis that these disorders are contagious. Tell those with bacterial conjunctivitis to avoid contact with other people for 24 hours after receiving antibiotic treatment; not to share towels, pillows, or cosmetic eye products; and not to wear contact lenses until the conjunctivitis resolves. Tell patients with allergic conjunctivitis that this type of inflammation isn’t contagious.
Eye pain:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes. Prepare him for diagnostic studies, including tonometry and orbital X-rays. Prepare to irrigate the eye, as ordered.
Patient teaching
Tell the patient that it’s important to seek medical help for eye pain and stress the importance of meticulous compliance with drug therapy to prevent an increase in IOP.
Eye discharge:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Inform patients that bacterial and viral conjunctivitis are contagious. Tell those with bacterial conjunctivitis to avoid contact with other people until 24 hours after receiving antibiotic treatment; not to share towels, pillows, or cosmetic eye products; and to stop wearing contact lenses until conjunctivitis resolves. Tell patients with allergic conjunctivitis that this isn’t a contagious type of inflammation.
Eye pain:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient’s eye pain results from a chemical burn, remove contact lenses, if present, and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to decrease intraocular pressure (IOP). If drug treatment doesn’t reduce IOP, the patient needs laser iridotomy or surgical peripheral iridectomy to save vision.
Doll's eye sign, absent [Negative oculocephalic reflex]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Don't attempt to elicit doll's eye sign in a comatose patient with suspected cervical spine injury; doing so risks spinal cord damage.
▪ Monitor vital signs and neurologic status.
▪ Discuss end-of-life issues with the patient's family, if appropriate.
▪ Provide emotional support to the family.
Patient teaching
▪ Explain to the patient the underlying cause and its treatment.
Eye pain [Ophthalmalgia]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes.
▪ Prepare the patient for diagnostic studies, including tonometry and orbital X-rays.
Patient teaching
▪ Stress the importance of following instructions for drug therapy.
▪ Teach the patient about ways to protect the eyes.
▪ Tell that the patient that he should seek medical attention for any eye pain.
▪ Explain the underlying cause of the patient's eye pain and its treatment.
Eye discharge:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Apply warm soaks to soften crusts on the eyelids and lashes, then gently wipe the eyes with a soft gauze pad.
▪ Carefully dispose of all used dressings, tissues, and cotton swabs to prevent the spread of infection.
Patient teaching
▪ Teach the patient to avoid contaminating the unaffected eye and to refrain from sharing pillows, wash cloths, eyedrops, or eye makeup with others.
▪ Discuss ordered diagnostic tests, including culture and sensitivity studies to identify infectious organisms.
▪ Explain the underlying cause of the patient's eye discharge and its treatment.
Raccoon eyes:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Keep the patient on complete bed rest.
▪ Perform frequent neurologic evaluations to reevaluate the patient's LOC.
▪ Check the patient's vital signs frequently; be alert for such changes as bradypnea, bradycardia, hypertension, and fever.
▪ To avoid worsening a dural tear, instruct the patient not to blow his nose, cough vigorously, or strain.
▪ If otorrhea or rhinorrhea is present, don't attempt to stop the flow; instead, place a sterile, loose gauze pad under the nose or ear to absorb drainage.
▪ Monitor the amount of drainage and test it with a glucose reagent strip to confirm or rule out CSF leakage.
▪ To prevent further tearing of the mucous membranes and infection, never suction or pass a nasogastric tube through the patient's nose.
▪ Observe the patient for signs and symptoms of meningitis, such as fever, photophobia, and nuchal rigidity, and expect to administer a prophylactic antibiotic.
▪ Prepare the patient for diagnostic tests, such as skull X-ray and a computed tomography scan.
▪ If the dural tear doesn't heal spontaneously, prepare the patient for contrast cisternography to locate the tear, possibly followed by corrective surgery, as ordered.
Patient teaching
▪ Explain the disorder and treatment plan.
▪ Explain the signs and symptoms of neurologic deterioration that require immediate medical attention.
▪ Explain activity limitations.
Setting-sun sign [Sunset eyes]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's vital signs and neurologic status.
▪ Elevate the head of the crib to at least 30 degrees, and monitor intake and output.
▪ Monitor ICP, restrict fluids, and insert an I.V. catheter to administer a diuretic.
▪ For severely increased ICP, prepare for ET intubation and mechanical hyperventilation to reduce serum carbon dioxide levels and constrict cerebral vessels.
▪ Anticipate therapy to induce a barbiturate coma or hypothermia therapy to lower the metabolic rate.
▪ Maintain a calm environment.
▪ Perform nursing duties judiciously because procedures may further increase ICP.
▪ Encourage the parents' help in calming the infant, and offer them emotional support.
Patient teaching
▪ Explain the underlying condition and its treatment to the patient's parents.
▪ Prepare the child and his family for surgical management of increased ICP and hydrocephalus, as appropriate.
Medications used to treat Retinoblastoma:
Note:You must always seek professional medical advice about any treatment or change in treatment plans.
Some of the different medications used in the treatment of Retinoblastoma include:
- Cyclophosphamide
- Cycloblastin
- Cytoxan
- Neosar
- Procytox
- Genoxal
- Ledoxina
- Dactinomycin
- Cosmegen
- Ac-De
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