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Leukocoria (also white pupillary reflex) is an abnormal white reflection from the retina of the eye. Leukocoria resembles eyeshine , but leukocoria can also occur in animals that lack eyeshine because their retina lacks a tapetum lucidum .
However, if the eyes are asymmetrically affected, i.e. one eye's optic nerve is more damaged than the other, it will produce an important sign called an afferent pupillary defect. [citation needed] Defective light perception in one eye causes an asymmetrical pupillary constriction reflex called the afferent pupillary defect (APD). [citation needed]
Careful clinical assessment could aid in accurate diagnosis of the cause of the visual field defect and loss of vision. Compressive lesions of the visual pathway, especially lesions affecting optic nerve require a multi-disciplinary approach involving neurosurgeon , physician as well as the ophthalmologist . [ 32 ]
The Marcus Gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye. [3] In the swinging flashlight test, a light is alternately shone into the left and right eyes. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at.
A complete physical examination is done to identify if a child has any associated systemic symptoms which may aid in a diagnosis of childhood cataracts. [4] In addition, a complete eye examination is done. [2] [4] This eye exam includes fixation, pupillary reflex test, and test for visual acuity. [4]
Diagnosis requires exclusion of other neurological, ophthalmological, and systemic conditions. [3] Any cause of optic neuropathy should be ruled out, including demyelinating (MOG antibody disease, multiple sclerosis, and neuromyelitis optica) and systemic disease (diabetic, toxic, nutritional, and infectious causes). [3]
The pupillary reflex results in the pupil constricting (left) and dilating (right) These include the pupillary light reflex and accommodation reflex . Although the pupillary response , in which the pupil dilates or constricts due to light is not usually called a "reflex", it is still usually considered a part of this topic.
For an adequate test, vision must not be entirely lost. In dim room light, the examiner notes the size of the pupils. The patient is asked to gaze into the distance, and the examiner swings the beam of a penlight back and forth from one pupil to the other, and observes the size of pupils and reaction in the eye that is lit.