Approach to the child with leukocoria
- Paul L Kaufman, MD
Paul L Kaufman, MD
- Director, Retina and Vitreous Disease and Surgery
- Thomas Eye Group, Atlanta, GA
- Jonathan Kim, MD
Jonathan Kim, MD
- Associate Professor of Ophthalmology
- Children's Hospital Los Angeles, USC Roski Eye Institute, USC Keck School of Medicine
- Jesse L Berry, MD
Jesse L Berry, MD
- Assistant Professor of Ophthalmology
- Children's Hospital Los Angeles, USC Roski Eye Institute, University of Southern California
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]. The differential diagnosis can be narrowed through a complete clinical and family history and a thorough ophthalmic examination.
Although transient leukocoria is occasionally caused by the reflection of a normal optic disc (called pseudoleukocoria), 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 . (See 'Referral' below.)
The evaluation and management of the child with leukocoria and a brief discussion of the common causes of leukocoria in children are presented here. Retinoblastoma is discussed separately. (See "Retinoblastoma: Clinical presentation, evaluation, and diagnosis".)
CAUSES OF LEUKOCORIA
The common causes of leukocoria in children include:
●Retinoblastoma (18 to 62 percent of cases) [9-11]
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- CAUSES OF LEUKOCORIA
- Persistent fetal vasculature
- Coats disease
- Retinopathy of prematurity
- Optic disc abnormalities
- Vitreous hemorrhage
- Hereditary retinal syndromes/retinal dysplasia
- Astrocytic hamartoma
- CLINICAL EVALUATION
- Physical examination
- OPHTHALMOLOGIC EXAMINATION
- External examination
- Muscle balance and alignment
- Slit lamp examination
- Dilated fundus examination
- Examination under anesthesia
- OTHER STUDIES
- LABORATORY EVALUATION