Leukocoria - Definition, Symptoms, Causes, Treatment, diagnosis

   

Leukocoria means "white pupil" and is a term used for the clinical finding of white pupil reflex. Leukocoria is caused by anomalies with the retina, lens or vitreous. It is often the first manifestation of a number of intraocular and systemic diseases. Assessment of leukocoria is part of the routine study.

In the first year of life, the asymmetry of the red reflex when viewed through a direct ophthalmoscope or torch is the most common presentation of leukocoria. The presence of leukocoria should give a sense of urgency for prompt treatment.. First of all, the presence of non-accidental head injuries should be excluded. Vitreous hemorrhage is usually the result of trauma, including non-accidental head injuries in infants.

Every patient with suspected non-accidental head injuries should undergo an emergent eye examination performed by an ophthalmologist. Other conditions that cause leukocoria are fetal vasculature, retinopathy in prematurity, cataracts, toxocariasis and vitreous hemorrhage.


Leukocoria - Definition, Symptoms, Causes, Treatment, diagnosis

Leukocoria Symptoms


Some common opthalmological conditions that may represent with leukocoria include uveitis, disease envelope, optical disks abnormalities and retinal dysplasia. Major sign and symptoms include abnormal size of pupil, reduced vision, decreased visual acuity, nystagtnus, strabismus, buphthalmos, microphthalmos, anterior chamber cells and flare etc.

Because leukocoria affects mainly children, the condition is detected when a parent or guardian sees the pupil is being white. However, in some cases, the underlying disease occurs as reuslt of  secondary strabismus and he cause is found during dilated fundus examination.

Leukocoria Causes


One of the most important signs of an intraocular tumor in children is leukocoria or white pupil reflex. There are many reasons for Icukocoria in children. Most often include congenital cataracts, retinal detachment due to retinopathy in premature, persistent hyperplastic primary vitreous and retinal telangiectasia. Retinoblastoma is probably the most serious cause of leukocytes in children.  Each child diagnosed with leukocoria must be treated immediately to avoid further prorgression of disease.

PHPV is the second most common cause of leukocoria in children. Clinically, PHPV is present as a one-sided Leukocoria. The condition is caused by damage to the hyaloid vasculature regresses with the resulting resistance of the primary vitreous. Since direct visualization with ophthalmoscopy may be difficult, in some cases, CT-Scan and MRI may be useful to make proper diagnosis. Few eyes that are not associated with calcifications and normally increased vitreous density are common to CT findings. MRI demonstrated microphthalmia and marked hyperintensity of vitreous TI-W and T2-W images. Retinal detachment and sub-retinal blood can be seen. The diagnosis is made by visualizing a Cloquet CT scan or magnetic resonance imaging.

Leukocoria Treament


Patient survival is the primary goal of the treatment of Leukocoria and retinoblastoma, and is indeed a priority, saving vision is of secondary importance. Advanced treatment of tumors is enucleation, which involves surgical removal of the entire eye and the optic nerve. This is the only way to eliminate the tissue of eye cancer to prevent recurrence and metastasis in other body sites. After surgery, patients are equipped with artificial eye (dentures) that have eye movement capabilities.

All eye vision and transplants are not available. Vision conservation procedures are also available, and include an external ray beam. Brachytherapy, photocoagulation, thermotherapy, cryotherapy and chemotherapy are also used for treatment. External radiation uses high energy rays to kill and reduce tumor cells, and in brachytherapy, radioactive plaques are implanted into the sclera.  Photocoagulation uses lasers to burn blood vessels that deliver nutrients to tumors and thermotherapy directly heating tumors with lasers or ultrasound.

Cryotherapy involves freezing the tumor by placing cryoprobes on the sclera near the tumor. These therapies are often used in a chemo chemotherapy suite that uses drugs to disrupt the ability of tumor cells to grow and multiply.

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