A child with esotropia and left leukocoria from retinoblastoma. Image from Wikipedia.
There are TONS of causes of leukocoria (white pupil). But this can be a very important differential, as it can be the presenting sign of some sight-threatening and life-threatening conditions (most obviously retinoblastoma). Because of its clinical importance, it is essential to be able to not only recognize what it is, but to also have a decent differential diagnosis so that you don’t miss out on any key causes when conducting a history and physical.
Given the sizable list of causes (a very short list is listed on the AAPOS website), I created a mnemonic that I could at least use to recall at least 3-5 (or more) causes of leukocoria. The mnemonic is “Leukocoria looks like CREAM PIGMENT“:
- Coats / Coloboma / Cataract
- Retinoblastoma / Retinal dysplasia / Retinoma / ROP / Retinal fold
- Endophthalmitis
- Astrocytic hamartoma / Anisometropia
- Myelinated NFL
- PFV
- Incontinentia pigmenti / Inflammation (uveitis)
- Granuloma
- Melanoma / Myopia / Medulloepithelioma
- FEVR
- Norrie
- Trauma / Toxocariasis
What do you think? Do you have any other tips on how to remember the differential for leukocoria? Leave a comment or contact us!