If possible, small retinoblastomas located towards the back of the eye are treated by heating the tumor with a laser. Tumors near the front of the eye are destroyed by cryotherapy (freezing). Treatment needs to be repeated several times to ensure the tumor has been completely destroyed.

If the tumor is too large to be treated with lasers or cryotherapy, chemotherapy is used. There are several methods for administering chemotherapy. The method we use depends on the location of the tumor or tumors.

  • Systemic chemotherapy is injected and spreads through the bloodstream to the entire body. It is used to treat both eyes at the same time as well as any possible or definite tumors in other parts of the body.
  • With intra-arterial chemotherapy, a long, narrow tube is gently inserted into a small incision in the groin, then passed through blood vessels in the the chest and neck and into a tiny artery behind the eye. Intra-arterial therapy is used to treat only one eye.
  • In intra-vitreal chemotherapy, the chemotherapy drug is injected directly into the middle of the eye. This is used if the tumor has scattered cancerous cells into the vitreous cavity (the space between the lens and the retina).

No matter which method is used, chemotherapy needs to be repeated several times, usually at monthly intervals.

If the chances of saving the eye are too small to justify exposing the child to chemotherapy and many anesthetics, the eye is removed. This operation is called "enucleation." When the eye is removed, a ball implant is buried in its place. The ocular muscles are sewn to this implant so that the artificial eye moves normally. Then, a contact lens-like prosthesis is custom made to match the color of the other eye. The prosthesis is fitted to the implant about six weeks after the enucleation.

Although it can sound frightening to parents, babies and young children often cope with enucleation remarkably well.

After the eye is removed, a pathologist will examine it to estimate the risk of retinoblastoma spreading (or "metastasizing") to other parts of the body. The risk of metastasis is higher if the tumor has spread beyond the retina into the optic nerve, the choroid (the blood-filled layer beneath the retina), or into the tissues outside the eye. Children with an increased risk of metastatic disease are treated with systemic chemotherapy as a precaution.


After treatment, children need to have frequent eye exams — usually every month until the age of 2 years, then less frequently until the age of 5, then every six months until the age of 9, and then once a year. These examinations are performed to detect any new or recurrent tumors when they are still very small and easier to treat.

The Care Team

At UCSF's Retinoblastoma Program, patients are cared for by a large team that includes ocular oncologists, pediatric oncologists, specialist nurses, interventional radiologists, social workers and other experts. We take special measures to ensure that parents have all the knowledge and support they need to achieve the best possible outcome for their child.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Retinoblastoma Program
1975 Fourth St.
San Francisco, CA 94143
Phone: (415) 514-6918
Fax: (415) 514-5711
Appointment information