A, Direct ophthalmoscopic examination of the right eye of patient 7 during an examination under anesthesia. External photograph demonstrating no leukocoria with undilated pupils. B, External photograph demonstrating leukocoria after pupillary dilation. Note that the leukocoria fills the pupil incompletely because of the small size of the lesion. C, Fundus photograph documenting a 2-mm flat, retinoblastoma tumor just superior to the optic nerve. Note: the lid speculum was used for photographic purposes during the examination under anesthesia, and is not necessary for the pupillary examination in the awake patient.
Composite retinal map drawing of the right and left eyes demonstrating the relative sizes and locations of retinoblastoma tumors that elicited leukocoria only after pupillary dilation. The numbers correspond to the individual patients (see Table 1). The inner circle represents the equator, the middle circle represents the ora serrata, and the outer circle represents the region of ciliary processes. The small circle in the center of the chart represents the optic nerve (1.5-mm diameter).