1 post published by pediatriceducationmin on January 2, There are many causes of leukocoria in children (table 1); the differential diagnosis can be narrowed through a complete clinical and family. Differential Diagnosis of Leukocoria. Jerry A. Shields and Carol L. Shields. ETINOBLASTOMA is a highly malignant. R intraocular tumor of childhood that re-.

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The primary sign is leukocoria. The tumor can actually be visualized behind the clear lens. Capillary growth on the line of demarcation forms a prominent diagnois stage 2a differeential that may reach beyond the retina, infiltrating the internal limiting membrane and extending into the vitreous stage 3.

Inflammatory conditions, in particular ocular toxocariasis, can lead to complex clinical features requiring a whole battery of investigations, including serology, ultrasonography, and neuro-diagnostic tools. Whether the family doctor or pediatrician, the primary care physician is usually the first to be confronted with the problem and thus plays an essential role, as the evolution and ultimate outcome diagnossis the disease will depend on the speed of reaction at this initial stage.

Leukocoria in the left eye of this infant with retinoblastoma. Noninvasive and well tolerated, it provides invaluable information on the presence of ,eukocoria, edema, or subretinal fluid in the macula. Learning Point Leukocoria can be caused by congenital or acquired eye diseases. It is difficult to assess the benign or malignant nature of the tumor, even on histopathological examination Broughton and Zimmerman Associated findings include microphthalmia, microcornea, shallow anterior chamber, persistent tunica vasculosa lentis, cataract, fine vessels coursing over the iris to the anterior lens surface, and retrolental fibrovascular membrane.

Differentila Contusion of the globe Intraocular foreign body Shaken baby syndrome. Astrocytic hamartoma in tuberous sclerosis presents as a flat Fig. How often does retinopathy of prematurity cause retinal detachment?

D/D Of Leukocoria (White reflex in eye) Mnemonics

Health care services aimed at preventing health problems or maintaining health are provided. A month-old boy was referred by his pediatrician because a whitish reflex from his left pupil Figure was noticed by his parents in certain directions of gaze.


Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.

Neuroimaging Clin N Am. News, Tips, Resources Morning Rounds: A review of the literature.

Almost always unilateral, this condition often presents with moderate microphthalmia and other associated malformations such as failure of cleavage of the anterior segment or uveal coloboma. Preschool or school-age children are most often affected and the first manifestations are usually exophthalmia and loss of vision Dutton,Hamelin et al A magnetic resonance imaging MRI scan showed no evidence of optic nerve or intracranial involvement.

Thus the importance of keeping in mind the possibility of retinoblastoma when confronted with suspicious signs such as a white pupil or duagnosis Figure1athe most common first manifestation, strabismus or any other unexplained diagonsis.

Keeping in mind a possible diagnosis of retinoblastoma is the first major step to a full recovery. Retinoblastoma represents the greatest challenge in leukocorka field of ophthalmology.

Papillary and intraocular involvement is possible but very rare. This article outlines a practical, stepwise approach to identifying key diagnostic findings in retinoblastoma and pseudoretinoblastomas.

Differential diagnosis of leukocoria and strabismus, first presenting signs of retinoblastoma.

The classification of retinal detachment. A red reflex exam is also warranted at every pediatric visit from birth to 3 years and, later, as part of vision screening. Consider toxocariasis if child is exposed to puppies or toxoplasmosis cats. Any patient with an abnormal red reflex should be evaluated promptly by an ophthalmologist. They also denied trauma. All positions of gaze should be leuokcoria, first of all in miosis then repeated with the pupil fully dilated, taking diagnpsis of mydriasis to detect any anomaly of the macular or papillary region on ophthalmoscopy.

Table 1 gives a classification by system and by frequency of diseases involved in the differential diagnosis of retinoblastoma. Both endo- and exophytic forms are likely to develop calcifications, in the form of chalky white patches within the tumoral mass.


It is important to note the presence diagnosix afferent pupillary defect, which may be a poor prognostic sign.

Available from the Internet at http: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! Journal List Clin Ophthalmol difderential.

Rarely, there may diagnosls linear dystrophic retinal calcifications from chronic retinal detachment at the level of RPE, unlike retinoblastoma, where the calcification is within the intraocular tumor. The most feared cause of a white reflex in the pupil is retinoblastoma, the most common intraocular tumor of childhood. According to the literature, the mean differentiwl of retinoblastoma is one in 20, live births Balmer and Munier b with no sex, race or geographic predilection and no known exogenous risk factors apart from the age of the parents, in particular that of the father DerKinderen et al ; Matsunaga et al The retinopathy may arrest spontaneously at any point of the natural course of the disease, the critical period being the stage when neovascularization invades the vitreous, the retroequatorial zone and posterior pole.

Strabismus is usually secondary to macular involvement and an invaluable early sign carrying an excellent life prognosis and every chance of preserving the globe. Table 1 Differential diagnosis in infantile leukocoria. A statistical survey of children. Please review our privacy policy. It can be differentiated from retinoblastoma by its lack of retinal detachment, lack of growth, and the course of retinal blood vessels under or around the astrocytic tumor.

A large retinoblastoma detected in a fetus at 21 weeks of gestation. There was no family history of retinoblastoma. Sign in via OpenAthens. Newer studies have indicated a somatic mutation in the NDP gene mutant in Norrie disease in Coats disease.

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