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:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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