Noticing a squint or a change in your child's vision can feel alarming. Most of the time there is a simple explanation — but a new squint in a young child deserves a prompt eye check, because in a small number of cases it can be an early sign of a tumour inside the eye. Getting checked early makes all the difference.
Medically reviewed by the CION Paediatric Oncology Tumour Board · Last reviewed June 2026
UNDERSTANDING THE SIGN
A squint — where one or both eyes point in a different direction — is usually caused by a muscle imbalance and is very treatable. But when a squint appears for the first time in a child who did not have one before, or when it comes on quickly, it deserves medical attention rather than a "wait and see" approach.
The reason for prompt evaluation is straightforward. Retinoblastoma — a tumour that grows inside the eye — is the most common eye cancer in children and most often affects children under five. A growing tumour can push the lens and retina out of alignment, causing a new squint. It can also affect how the eye reflects light, which is why parents sometimes spot an abnormal white or yellow glow — called leukocoria — in one eye in photographs, instead of the normal red-eye reflection seen in flash photos.
Retinoblastoma is one of the most treatable childhood cancers when found early. The goal of seeing a specialist promptly is not to alarm you — it is to rule out the serious cause quickly and, if needed, start care before the tumour has a chance to grow further.
A vision change in a child linked to a tumour does not always cause pain. Children rarely complain of eye discomfort even when something significant is happening inside the eye. That is why the physical signs — the squint, the unusual reflection, the change in appearance of one eye — matter so much, and why parents who notice something different are right to act on that instinct.
Retinoblastoma accounts for about 3% of all childhood cancers worldwide and is almost exclusively a disease of young children — the large majority of cases are diagnosed before age five. When the tumour is confined inside the eye at diagnosis, the outcome for a child's life is very favourable with appropriate treatment. Early detection — often triggered by a parent noticing an unusual eye appearance — is the single biggest factor in preserving both life and vision. (Source: International Retinoblastoma Staging Working Group / IRSG guidelines)
RECOGNISE THE SIGNS
These signs do not always mean cancer — most of the time they have a straightforward explanation. But each one deserves a medical review, ideally within a few days of being noticed, so the cause can be identified and treated.
If one eye shows a white or yellowish reflection in flash photographs — where the other eye shows the usual red — this is called leukocoria or "white pupil". It is one of the earliest visible signs of retinoblastoma and should prompt an urgent ophthalmology appointment within days. Not every white reflex is cancer, but it always needs investigation.
When a squint appears for the first time — rather than being present from infancy — a doctor needs to understand why. In a young child, a sudden misalignment of the eyes is worth checking promptly to rule out tumour-related causes. Most new squints have non-cancer causes, but an early review gives you that reassurance or finds the problem quickly.
An eye that remains red or sore beyond a week of appropriate treatment, or one that looks swollen or larger than the other, should be examined by a specialist. Tumours inside or behind the eye can cause inflammation and raised pressure that mimic ordinary eye infections.
A visible difference in the position of the eyes — where one appears to sit further forward or higher — can be caused by a tumour pressing from behind or within the eye socket (orbit). This sign needs specialist review on the same week it is noticed.
Young children rarely verbalise vision problems — watch for clues such as holding objects very close, covering one eye habitually, bumping into things more often, or becoming reluctant to do activities that require sight. A sudden or noticeable change in what a child can see deserves a same-week assessment.
Around four in ten cases of retinoblastoma are linked to an inherited change in the RB1 gene. If a parent, sibling, or close relative has had retinoblastoma, a child should have regular dilated eye examinations from birth even without any visible symptoms. You do not need to wait for a sign to appear before seeking screening.
Important: This page is for information only and does not replace a medical assessment. If you are concerned about your child, please arrange a consultation with a paediatric specialist promptly.
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Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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WHAT HAPPENS NEXT
We understand that bringing a child in for a cancer-related concern is frightening. Here is exactly what happens at each step so there are no surprises.
The paediatric oncologist will talk with you carefully about when the squint or vision change appeared, how quickly it came on, whether there is any family history, and how your child has been generally. A thorough physical exam follows. No part of this visit is rushed. You will have time to ask every question you have.
The doctor uses an ophthalmoscope to examine the inside of each eye and look for the normal red reflex. In young children, a detailed examination of the entire retina often needs to be done under short general anaesthesia so the child stays still and the doctor can see clearly. This is a brief, safe procedure done in a specialist setting.
Ultrasound of the eye can measure any mass inside and look for calcification patterns. An MRI of the eye, orbit, and brain is used when a tumour is suspected, to check whether it has extended beyond the eye to the optic nerve or further. These scans are non-invasive and provide the information needed to plan any treatment.
If the findings suggest retinoblastoma — or if there is a family history — genetic testing for changes in the RB1 gene is offered. This information helps guide surveillance for siblings and other family members who may carry the same gene change, even before any visible signs appear.
If a diagnosis of retinoblastoma or another eye tumour is confirmed, your child's case is presented to a tumour board — a team that includes a paediatric medical oncologist, radiation oncologist, ophthalmic surgeon, and pathologist — before any treatment is started. This is not one doctor's decision. It is a coordinated plan built to give your child the best chance of preserving both their life and their vision.
Reach out today — our paediatric oncology team will call you back, answer your questions, and explain what the next step should be for your child.
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HOW WE SUPPORT YOUR FAMILY
At CION Cancer Clinics, care for a child with a possible eye tumour involves multiple specialists working as one coordinated team. A paediatric medical oncologist, a radiation oncologist, an ophthalmic oncologist, a pathologist, and a paediatric psychologist all contribute to the plan for your child. No decision is made by one doctor working alone.
Our 17 oncologists across 35+ centres in Telangana and Andhra Pradesh hold a joint tumour board review for every patient. This means the advice you receive represents the full weight of the team's experience — not just a single opinion. For parents, this means you walk into every conversation knowing that the plan in front of you has been carefully considered from every clinical angle.
We also understand that this is one of the most frightening moments a parent can face. Beyond clinical care, we offer:
If your child is ultimately found not to have cancer — which is the outcome in many families who come to us — you leave with a clear diagnosis, a clear explanation, and the certainty that nothing was missed. That peace of mind has real value.
A 45-minute consultation with a specialist costs nothing. It gives you a clear answer about your child's eye health and what — if anything — needs to happen next.
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