What lays beneath a neglected ocular trauma in a child?

Aim of study:The diagnosis of leukocoria may be missed especially in a context of ocular trauma.We report the case of a 3 years old boy, incidentally diagnosed with bilateral retinoblastoma after a neglected penetrating globe injury caused by a sharp wooden object in OD.Material and method: Initial clinical evaluation detected in OD marked conjunctival congestion, "cork-screw" dilated episcleral vessels, buphthalmos with enlarged corneal diameter (Ø=18 mm), corneal edema, 2mm hyphema, iris neovascularization with active bleeding, shallow anterior chamber (AC), non-reactive mydriatic pupil, partially opacified lens and increased intraocular pressure (IOP=46 mmHg); in the infero-nasal quadrant the scleral wall seemed discontinue, but underlying uvea and a large adjacent hematoma sealed the scleral wound.In OS clinical examination revealed severe uveitis signs: 360 o posterior iris synechiae, a 3 mm hypopion, dense pupillary fibrinoid membrane and white cataract.Ultrasound examination (mode B) revealed massive vitreous hemorrhage and choroidal hematomas, more prominent in OD.Intensely hyper-reflective images, pleading for intraocular calcifications (Ø=1-3mm) were identified in both eyes.Total retinal detachment (funnel shape) was visible in OS.Cerebral computer tomography (CT) scan confirmed bony density (≈1000UH) of the intraocular hyperreflective images, highly indicative for bilateral multiloculated retinoblastoma; extraocular extensions towards the anterior orbit and optic nerve were described in OD.Extended enucleation with long optic nerve stump was completed in OD; pathology described extremely aggressive (Ki67=58%), anaplastic retinoblastoma (pT4Nx -G3L1V1Pn1) with both endo-and exophytic growth pattern, involving anterior intraocular structures, orbital fat tissue and adjacent striated muscular fibers, optic nerve and lamina cribrosa.Karyotype analysis was normal.After discharge, patient was referred to Pediatric Oncology for further adjuvant treatment, but rapid systemic spread was noted with extreme alteration of life quality and guarded survival rate, despite all efforts.Conclusion: Neglected initial diagnosis, delayed presentation dictated by ocular trauma prevented proper timely management and better survival rate in such case.