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
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 . (See 'Referral' below.)
CAUSES OF LEUKOCORIA
The common causes of leukocoria in children include:
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- Canzano JC, Handa JT. Utility of pupillary dilation for detecting leukocoria in patients with retinoblastoma. Pediatrics 1999; 104:e44.
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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
- Anisometropic amblyopia
- CLINICAL EVALUATION
- Detection of leukocoria
- Physical examination
- OPHTHALMOLOGIC EXAMINATION
- External examination
- Extraocular motor evaluation
- Slit lamp examination
- Dilated fundus examination
- Examination under anesthesia
- OTHER STUDIES
- LABORATORY EVALUATION