Leukocoria

Leukocoria, the presence of a white pupil

in an infant or young child, is a sign of an
underlying disorder and not a diagnosis itself.
The most common causes of leukocaoria:
-Retinoblastoma (50% of cases)
-Persistent hyperplasic primary vitreous (28% of cases).
-Coat's disease (16% of cases).
-Retinopathy of prematurity (5% of cases).
-Toxocariasis
-Congenital cataract
-Corneal opacity.
-Endo/ panophthalmitis
-Toxoplasmosis.
-Retinal astrocytoma.
-Retinal dysplasia.
Retinoblastoma:
Retinoblastoma, the most common pediatric
intraocular neoplasm, is a highly malignant
tumor of the primitive neural retina.

Clinical features:
Retinoblastoma may present in variety of
ways:
Leukocoria or "amoaurotic cat's eye" is a
white pupillary reflex (in 70% of cases).
Strabismus (2% of cases)
Secondary glaucoma (3% of cases).
Diagnosis:
Complete ophthalmic examination
Indirect ophthalmoscope.
X-Ray of the globe – using bone – free dental
film.
Ultrasonogrophy.
CT- scan, MRI

Finding:
retinoblastoma is unifocal or multifocal
elevated white mass
Treatment:
Enucleation –for large or when the chance of
retaining useful vision is extremely small.
Radiotherapy – for medium or large tumors .
Brachytherapy- for large tumors.
Photocoagulation – for small tumors located
posterior to equator.
Cryotherapy- for small retinoblastomas
located anterior to the equator.
Chemotherapy- Indicated following
enucleation in advanced cases and in the
presence of metastasis.
Persistent hyperplasic primary vitreous (PHPV).
It is the most serious developmental disorder of the
vitreous. It is caused by a failar of regression of the
primary vitreous.

Clinical features:
Anterior PHPV:
It typically occurs in a microphthalmic eye.
Unilateral in about 90% of cases.
Presence of a retrolent mass into which elongated
ciliary processes.
Posterior PHPV:
Presence of white dense opaque membrane
which extend from the optic disc to the more
peripheral retina or the retrolent region.

Treatment:
Lensectomy and removal of the retrolental
fibrovascular membrane.
Coat's disease
Coat's disease, or congenital retinal teleangiectasic
occur more common in males (70%)
Unilateral in 90% of cases.
Typically presents in the first decad of life with a
white fundus reflex (leukocoria).

Diagnosis:
Ophthalmoscope, B-scan

Treatment:
Cryotherapy or photocoagulation to stop leaking blood
vessels.
Coa’ts disease – central exudative retinitis

Extensive subretinal exudate

Coa’ts disease
Fluorescein angiogram – Telangiectasia
microaneurysms
Retinopathy of Prematurity (ROP):
It is a proliferative retinopathy which typically
affects premature infants exposed to high
oxygen concentration.

Clinical features:
Retinopathy of prematurity is a bilateral
disease.
Treatment: (ROP)
Photocoagulation or cryotheropy only when
definitely progressive.
Scleral bucking with or without vitrectomy for
treatment tractional detachment.
Toxocariasis:
Toxocariasis is an infestation caused by a common
intestinal roundworm of cat's (Toxocar cati) and
dogs (Tococara canis).
Ocular toxocariasis:
The most common ocular lesion are:
Chronic endophthalmitis (between the age of 2 to 9
years)
Peripheral granuloma (between the age 6 and 40
years).
Posterior granuloma (between the age of 6 to 14
years).
Toxocariasis:

Treatment:
Antihelmintic combined with sterior medication:
Thiabendazole 500gm P.O. qid for 5 days + 40 mg
prednisone P.O qd for 10 days.
periocular and systemic steroids may also be used in
severe cases.
Scleral bucking for rhegmatogenous retinal
detachment.
Vitrectomy – for retrolental traction, vitreoretinal
traction.
:Toxoplasmossis
.This is a protozoan infection derived mainly from cats
Toxoplasma ganadii, usually congenital (transplacental
.transmission)

:Clinical features
•Posterior uveitis.
•Vitritis
•Choriorotinal lesions – appear as yellow – white patches
of necrotizing retinitis.
•Chorioretinal scar in the posterior pole, of ten in the
macula.
•Microphthamia, nystagnus, squint.
:Retinal astrocytoma
A rare benign non vision threatening tumor, most
frequently seen in patients with tuberous sclerosis, most
.common appearance semi translucent nodular lesion
Less common appearance white relatively flat
.circumscribed lesion
Thank you,,