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Approach to the child with leukocoria

Paul L Kaufman, MD
Jonathan Kim, MD
Jesse L Berry, MD
Section Editor
Evelyn A Paysse, MD
Deputy Editor
Carrie Armsby, MD, MPH


Leukocoria describes the clinical finding of a white pupillary reflex (picture 1). There are many causes of leukocoria in children (table 1); the differential diagnosis can be narrowed through a complete clinical and family history and a thorough ophthalmic examination.

An overview of the causes of leukocoria in children and an approach to the diagnostic evaluation are presented here. Retinoblastoma is discussed in detail separately. (See "Retinoblastoma: Clinical presentation, evaluation, and diagnosis" and "Retinoblastoma: Treatment and outcome".)


Leukocoria – The term leukocoria means "white pupil" (from the Greek "leukos" meaning white and "kore" meaning pupil) and is the name given to the clinical finding of a white pupillary reflex (picture 1). Leukocoria can be caused by abnormalities in the lens (eg, cataract), vitreous (eg, hemorrhage), or retina (eg, retinoblastoma) (table 1) [1,2]. It can be the initial manifestation of a wide spectrum of intraocular and systemic disease processes [3-7].

Pseudoleukocoria – Pseudoleukocoria refers to transient leukocoria that is caused by reflection of a normal optic disc. Though this occasionally occurs, all children with newly discovered leukocoria should be referred urgently (ie, within one week) to an ophthalmologist to exclude retinoblastoma and other life- or sight-threatening conditions [8]. (See 'Referral' below.)


The common causes of leukocoria in children include:

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Literature review current through: Nov 2017. | This topic last updated: Nov 27, 2017.
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