Causes of Leukocoria: CREAM PIGMENT

 A child with esotropia and left leukocoria from retinoblastoma. Image from  Wikipedia .

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!