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Causes of White Pupillary Reflex Differential Diagnosis Leukocoria

white pupillary reflex causes and differential diagnosisWhite pupillary reflex is the whitish appearance of pupil. This condition is also known as leukocoria. It can occur in a number of conditions. 
Following are the causes of white pupillary reflex in early life and these causes must be included in the differential diagnosis.

1. Congenital Cataract

A congenital cataract is the congenital opacity of the lens of the eye. When light is thrown into the eye it gives white pupillary reflex.

2. Retinoblastoma

It is a congenital tumour of retina. It is a life-threatening malignant condition and it usually occurs within the first three years of life.

3. Retrolental fibroplasia

(Retro = behind, Lental = Lens). It is a disease of the retina. It usually occurs in premature infants who are kept in incubators under high pressure of oxygen. High oxygen has been identified as a case of retrolental fibroplasia. It is a fibrovascular mass present behind the lens. It impairs the vision and it gives white pupillary reflex on examination.

4. Anterior Persistent Hyperplastic Primary Vitreous (APHPV)

Developing lens has a nutritional vascular supply which regresses after birth. In APHPV primary vitreous of fetal life persists along with the vascular after birth. It is present behind the lens and don’t allow light rays to reach the retina and give white pupillary reflex on examination.

5. Coat’s Disease

It is a congenital retinal vascular abnormality. In this condition, retinal vessels are not well formed and their continuous leakage results in exudation and retinal detachment. It also gives white pupillary reflex on examination.

6. Endophthalmitis

It is the inflammation of intraocular cavities. It is a dangerous condition and if remains untreated, invariably lead to blindness. It also causes white pupillary reflex.

7. Toxocarial Granuloma

It is an inflammatory condition that occurs due to the presence of larvae in the vitreous chamber of the eye. On examination, it too gives white pupillary reflex.

How to make a diagnosis.

The intraocular examination is needed to make a clear diagnosis. Fundoscopy and slit lamp examination should be done. If fundus of the eye can’t be visualized due to lens or corneal opacities then an ultrasound scan (B-Scan) should be performed to exclude retinal causes.
References:
  1. Leukocoria https://en.wikipedia.org/wiki/Leukocoria
  2. White pupillary reflex causes, Jones.H et al, 2011, Journal of Ophthalmology
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