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Leukocoria (from Greek leukos = white, kore = pupil) refers to a white pupillary reflex observed clinically or in photographs (instead of the normal red reflex).
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It is a sign, not a diagnosis, and always warrants urgent evaluation, especially in children, to rule out sight- or life-threatening conditions.
Leukocoria (white reflection in the pupil) | Aerts, I., Lumbroso-Le Rouic, L., Gauthier-Villars, M., Brisse, H., Doz, F., & Desjardins, L. (2006). Retinoblastoma. Orphanet journal of rare diseases, 1, 31. https://doi.org/10.1186/1750-1172-1-31
| Etiology | Pathology |
|---|---|
| Intraocular tumors | • ‣ (most important, life-threatening, commonest cause in children). |
| • ‣ (rare). | |
| Developmental / congenital anomalies | • Persistent fetal vasculature (PFV, persistent hyperplastic primary vitreous). |
| • ‣ (retinal telangiectasia with exudation). | |
| • ‣ | |
| • ‣ | |
| • Coloboma involving the macula/optic disc. | |
| Acquired causes | • ‣ (ocular larva migrans). |
| • ‣ (tractional/exudative). | |
| • Intraocular hemorrhage. | |
| • Endophthalmitis. | |
| Miscellaneous | Asteroid hyalosis (rarely produces leukocoria). |
Associated symptoms/signs:
| Cause | Key Imaging/Clinical Clue | Notes |
|---|---|---|
| ‣ | Intraocular mass with calcification (US/CT/MRI) | Commonest, life-threatening |
| Congenital cataract | Lens opacity on slit lamp/US | Treat early to prevent amblyopia |
| PFV | Retrolental stalk, microphthalmia | Unilateral, non-hereditary |
| ‣ | Exudative retinal detachment, no calcification | Males, unilateral |
| ROP | History of prematurity, tractional detachment | Bilateral |
| ‣ | Granuloma with tractional detachment | Often unilateral |
| Retinal detachment | V-shaped membrane (US) | Acquired cause |