PEDIATRICS Vol. 104 No. 4
October 1999,
p. e44
ELECTRONIC ARTICLE:
Utility of Pupillary Dilation for Detecting Leukocoria in
Patients With Retinoblastoma
Received Apr 2, 1998; accepted Apr 15, 1999.
John C. Canzano and
James T. Handa
From the Department of Ophthalmology, University of California,
Davis, Sacramento, California.
In the United States, 50% of all retinoblastoma
cases are diagnosed after the observation of leukocoria by a family
member or primary care physician. However, leukocoria produced by
retinoblastoma lesions can often be missed by direct ophthalmoscopic
examination through an undilated pupil. The purpose of this study is to
demonstrate the utility of pupillary dilation for the detection of
leukocoria in suspected cases. Seven patients (10 eyes), aged 2 days to
20 months, with retinoblastoma were examined for leukocoria using a
direct ophthalmoscope with the pupils first undilated and then after
pharmacologic dilation with 0.5% cyclopentolate and 2.5% phenylephrine. Leukocoria was detected by direct ophthalmoscopy on
undilated examination in 3 of 10 eyes (30%). In contrast, leukocoria was observed after pupillary dilation in 10 of 10 eyes (100%). The
retinoblastoma lesions, from 2 to 10 mm in diameter, were located
within the posterior 45° of the retina. Pupillary dilation is a safe
and effective tool that can enhance the ability of the examiner to
detect leukocoria. Dilation may afford early diagnosis and treatment,
and therefore should be considered on patients in whom the diagnosis of
retinoblastoma is entertained.
Key words:
direct ophthalmoscope,
leukocoria,
pupillary dilation,
retinoblastoma.
