Good evening Curofians. Spotter : Eye A. What is your diagnosis? B. Describe your findings. C. What is your next step? D. Differential diagnosis. Thank you. (Courtesy : Internet)



Revered sirs and madams good evening. SUGGESTIVE KEY : Q1. What is your diagnosis? Mostly unilateral (Left sided) retinoblastoma. Q2.Describe your findings? Left eye shows a white pupillary reflex also called as leukocoria. Q3.What is your next step? Complete eye examination should be performed including an estimation of patient's visual acuity for both eyes followed by a dilated fundus examination with indirect ophthalmoscopy. Q4. Differential diagnosis. Most common - A. Toxocariasis, B. Persistent hyperplastic primary vitreous (PHPV), C. Coats disease. Others - D. Retinopathy of prematurity, E. Incontinentia pigmenti, F. Norrie disease, G. Medulloepithelioma, H. Retinal dysplasia, I. Retinal astrocytomas, J. Astrocytic hamartomas, K. Colobomas, L. Myelinated nerve fibers, N. Congenital cataract, O. Retinal detachment, P. Vitreous hemorrhage, Q. Trauma. Thank you very much for your participation. Comments are welcome.

Thank you Dr. Hussain for giving the summary.

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A. Leukocoria or Amaurotic cats eye reflex B. The pupil on the left eye of the child shows a characteristic yellowish white reflex when compared to the right pupil which appears jet black. C. D/D... 1. Retinoblastoma 2. Congenital cataract 3. Coats disease or retinal telangiectasia 4. Retrolental fibroplasia 5. Persistent hyperplastic primary vitreous 6. Toxocara endopthalmitis D. The next step in the diagnosis is FUNDOSCOPY. Regards...

i think all D/D have been put toghter. next would be EUA under GA for complete eye assessment followed bya radiological investigation probably CT SCAN

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Lukocoria ,retinoblastoma lt eye Rule out other caues Cataract,retinal detachment, retinopathy of prematuarity,retinal vascular abnormality as Coat’s disease White pupil primary sign of retinoblastoma differentiate from other causes psuedoblastomas already enumorated Mostly first noted by family or on flash photography with 15degree of axis nasally the optic disc can fill the pupil giving white reflex Red reflex exam is is warranted at every visit from birth to three year as part of screening Age of onset, duration of white reflex previous red reflex rule out congenital condition Other symptoms pai, redness photophobia, strabismus and blurred vision Historyof retinopathy of prematuarity, trauma, prenatal infection TORCH syndrome toxoplasmosis, other agentas,rubella, cytomegalovirus& herpes simplex may show white teflex Tuberous sclerosis associated with retinal astrocytomas , endogenous endophthalmitis these all in mind can lead to exact diagnosis

Dx :Blue sclera both eyes : Dx : Lt eye yellow reflex in pupil. D.D : (blue sclera) Osteogenesis imperfecta. Marfan's syndrome. D.D : (yellow reflex in pupil). Retinoblastoma. Endophthelmitis Persistent hyperplastic primary vitreous. Cataract (White reflex in pupil). * Pt is to be investigated under GA for BOTH eyes fundus examination & iop measurements. * Rx : Rx will depend upon the cause.

Retinoblastoma is the most common intraocular tumor of childhood. About 75% of the sporadic tumors are caused by somatic mutations and are not transmissible. Sporadic tumors caused by somatic mutations are always unilateral. Unfortunately, unilateral involvement does not exclude heritable disease: about 10% to 15% of infants with unilateral sporadic tumors have heritable germinal mutations. about 90% of patients present with leukocoria, an abnormal, typically white pupillary reflex. Leukocoria is the classic clinical manifestation of retinoblastoma. In the older literature, this finding was fancifully likened to the illuminated tapetal light reflex of the cat (amauroticl cat's - eye reflex). The white pupillary reflex is caused by tumor in the vitreous cavity

Revered Dr. Mohammed Parvez sir thank you for your participation. Suggestive key for this case is posted by me, below.

OSTEOGENESIS IMPERFECTA (brittle bone disease) with ?retinoblastoma

Revered Dr. Zuber Ahmed Khan sir thank you for your participation. Suggestive key for this case is posted by me, below.

retinoblastoma yellowish white pupillary reflex in left eye fundoscopy, b scan, other eye examination congenital cataract ...endohthalmitis....rd ...phpv

Revered Dr. Chandrika Br madam, thank you for your participation. Suggestive key for this case is posted by me, below.

Retinoblastoma showing leucocoria

Revered Dr. Jain madam, thank you for your participation. Suggestive key for this case is posted by me, below.

Retinoblastoma leucocoria CTA scani orbit, screen for other eye, enucleation, radiotherapy, congenital cataract, toxacara canis, PHPV

Revered Dr.Nayeemuddin Mohammed thank you for your participation. Kindly go through the key posted by me.

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Revered Dr. Reyaz Malla sir, thank you for your participation. Suggestive key for this case is posted by me, below.
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