Differential Diagnosis for White Reflection on Left Pupil in a Three-Year-Old
When assessing the red reflex, a white reflection, also known as leukocoria, can be indicative of several conditions. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Retinoblastoma: This is the most common primary malignant intraocular tumor in children, and leukocoria is one of its classic presentations. The white reflection is due to the tumor's presence in the retina, which disrupts the normal red reflex.
Other Likely Diagnoses
- Cataract: A cataract can cause a white opacity in the lens, leading to leukocoria. This condition can be congenital or acquired.
- Coats Disease: This condition is characterized by abnormal blood vessel growth in the retina, which can lead to retinal detachment and leukocoria.
- Persistent Fetal Vasculature (PFV): PFV is a congenital anomaly where the fetal vasculature fails to regress, leading to a white pupillary reflex.
Do Not Miss Diagnoses
- Retinal Detachment: Although less common, retinal detachment can cause leukocoria and is a medical emergency requiring prompt treatment to preserve vision.
- Medulloepithelioma: A rare, malignant tumor of the ciliary body that can present with leukocoria.
- Intraocular Infection or Inflammation: Conditions like endophthalmitis or uveitis can cause a white reflex, although they are less common in this context.
Rare Diagnoses
- Coloboma: A congenital defect in the structure of the eye, which can affect the iris, retina, or optic nerve, potentially causing leukocoria.
- Norrie Disease: A rare, X-linked genetic disorder that affects the retina and can cause leukocoria.
- Intraocular Cysts or Tumors (e.g., retinal cysts, choroidal osteoma): These are rare conditions that can cause a white reflex but are less likely than the previously mentioned diagnoses.