Summary about Disease
Leukocoria, often referred to as a white pupil, is an abnormal white reflection from the retina of the eye. It is not a disease itself, but rather a sign of an underlying medical condition. It is most often detected in childhood and can be a sign of serious eye conditions, the most critical being retinoblastoma (a childhood cancer of the retina). Early detection and diagnosis are vital for proper treatment and preservation of vision and even life.
Symptoms
The primary symptom of leukocoria is a white, milky, or cat's eye reflection in the pupil, especially noticeable in photographs taken with a flash. Other possible symptoms depend on the underlying cause and can include:
Strabismus (crossed or misaligned eyes)
Vision problems
Eye pain or redness (less common)
Dilated pupil
Difference in eye size
Glaucoma (elevated eye pressure)
Causes
Several conditions can cause leukocoria, including:
Retinoblastoma: The most serious cause; a malignant tumor of the retina.
Congenital Cataracts: Clouding of the lens present at birth.
Retinopathy of Prematurity (ROP): Abnormal blood vessel development in premature infants.
Coats' Disease: Abnormal blood vessel development behind the retina.
Ocular Toxocariasis: Infection of the eye by a parasitic worm.
Persistent Hyperplastic Primary Vitreous (PHPV): Failure of the fetal blood supply to the eye to regress normally.
Coloboma: A gap in one of the structures of the eye.
Retinal Detachment: Separation of the retina from the underlying tissue.
Medicine Used
The "medicines used" to treat leukocoria depend entirely on the underlying cause. There is no single medicine that treats leukocoria itself. Examples include:
Retinoblastoma: Chemotherapy, radiation therapy, laser therapy, cryotherapy, surgery (enucleation - removal of the eye)
Congenital Cataracts: Surgery to remove the cataract, followed by corrective lenses or an intraocular lens implant.
Retinopathy of Prematurity (ROP): Laser therapy or injections of anti-VEGF medications to stop abnormal blood vessel growth.
Coats' Disease: Laser therapy or cryotherapy to seal off leaking blood vessels.
Ocular Toxocariasis: Anti-parasitic medications, corticosteroids.
Is Communicable
Leukocoria itself is not communicable. However, certain underlying causes may or may not be communicable. For example:
Ocular Toxocariasis: Caused by infection with larvae of the roundworm Toxocara canis. Can be contracted by accidentally ingesting dirt contaminated with dog or cat feces that contain *Toxocara* eggs.
Other causes such as retinoblastoma, congenital cataracts, ROP, Coats' disease: These are non-communicable.
Precautions
Precautions primarily involve early detection and prevention where possible. These include:
Routine Eye Exams: Regular eye exams for children, especially infants and toddlers, are crucial for early detection.
Newborn Screening: Ensuring that newborns receive the appropriate eye screenings.
Prematurity Care: Careful monitoring and treatment of premature infants to prevent or manage ROP.
Hygiene: Practicing good hygiene, particularly handwashing, to prevent parasitic infections like ocular toxocariasis.
Genetic Counseling: If there is a family history of retinoblastoma, genetic counseling is important to assess risk and discuss screening options.
How long does an outbreak last?
Leukocoria is not an outbreak situation, but a sign of an underlying medical condition. The duration of the condition depends on the underlying cause and its treatment.
How is it diagnosed?
Diagnosis involves a comprehensive eye examination by an ophthalmologist. This includes:
Visual Acuity Testing: To assess vision.
Pupil Dilation: To examine the retina.
Ophthalmoscopy: Examination of the retina with a specialized instrument.
Imaging Studies: Ultrasound, CT scans, or MRI may be used to further evaluate the eye and surrounding structures, particularly to rule out retinoblastoma.
Fluorescein Angiography: A dye is injected into the bloodstream to visualize blood vessels in the retina.
Genetic Testing: May be performed if retinoblastoma is suspected.
Timeline of Symptoms
The timeline of leukocoria symptoms depends on the underlying cause.
Retinoblastoma: Leukocoria may appear gradually over weeks or months.
Congenital Cataracts: Leukocoria is present at birth or shortly thereafter.
ROP: Develops in premature infants, typically within weeks after birth.
Coats' Disease: Can develop gradually over months or years.
Ocular Toxocariasis: Symptoms may appear weeks or months after infection.
Important Considerations
Urgency: Leukocoria is always a serious finding and requires immediate medical attention.
Differential Diagnosis: It is crucial to rule out retinoblastoma as quickly as possible.
Multidisciplinary Approach: Treatment often involves a team of specialists, including ophthalmologists, oncologists, and geneticists.
Parental Awareness: Parents should be educated about the importance of early detection and reporting any unusual eye signs in their children.
Prognosis: The prognosis depends on the underlying cause and the stage at which it is diagnosed. Early detection and treatment significantly improve the chances of preserving vision and, in the case of retinoblastoma, saving the child's life.