بنام خداوند بخشنده مهربان Gh.Naderian M.D Isfahan University of Medical Scinces Department of Opthalmology

leukocoria

Leukocoria Definition : A white pupillary reflex

Leukocoria in a child requires urgent attention , primarily because in most patients with retinoblastoma it is the first sign noticed .

Secondarily , a white pupil indicates a severely amblyopiogenic condition , which may be treatable .

Anatomic location is important in the diffential diagnosis of Leukocoria .

Normally , only the lens is found immediately behind the pupil , so an opacity here indicates a cataract .

Advanced cases of persistent hyperplastic primary vitreous (PHPV)/persistent fetal vasculature (PFV) can also present with a posterior or total cataract.

A cataract dose not exclude other causes of leukocoria A cataract dose not exclude other causes of leukocoria . Therefore thoroughly examine the remainder of the eye.

Cells or clumps in the vitreous indicate hemorrhage , infection , or tumor.

Calcium in a retinal mass is highly typical for retinoblastoma, although not entirely pathognomic .

Chorioretinal colobomas vary from very small to encompassing most of the fundus and optic nerve.

Causes of Retinal Detachment in Children ■ Retinopathy of prematurity ■ Systemic diseases Incontinentia pigmenti Familial exudative vitreoretinopathy ■ Trauma ■ Toxocara ■ Coat’s disease

Work –up 1- History 2- Complete ocular examination 3- B Scan ultrasonoghraphy 4- Intravenous fluorescein angiogram (coats disease , ROP, retinoblastoma ) 5- CT or MRI 6- Serum ELISA 7- Anterior chamber paracentesis 8-EUA

NOTE : Anterior chamber paracentesis in a patients with a retinoblastoma can possibly led to tumor cell dissemination

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