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eye related issues

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 number of conditions. 

Following are the causes of white pupillary reflex in early life and these causes must be included in differential diagnosis.

1. Congenital Cataract

Congenital cataract is the congenital opacity of the lens of the eye. When light is thrown in to the eye it give white pupillary reflex.

2. Retinoblastoma

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

3. Retrolental firbroplasia

(Retro = behind, Lental = Lens). It is a disease of 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 impair the vision and it gives white pupillary reflex on examination.

4. Anterior Persistent Hyperplastic Primary Vitreous (APHPV)

Developing lens has 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 retina and give white pupillary reflex on examination.

5. Coat’s Disease

It is 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 intraoccular cavities. It is a dangerous condition and if remains untreated, invariably lead to blindness. It also cause white pupillary reflex.

7. Toxocarial Granuloma

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


How to make diagnosis.

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 ultra sound scan (B-Scan) should be performed to exclude retinal causes.


  1. Leukocoria
  2. White pupillary reflex causes, Jones.H et al, 2011, Journal of Ophthalmology

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