Pupils appear yellow-white reflections

Introduction The yellow-white reflection of the pupil is a symptom of retinoblastoma. When the tumor begins to grow in the eye, the external eye is normal. Because the child is young, it is impossible to report whether or not there is visual impairment. Therefore, the early stage of the disease is generally not easily found by parents. When the tumor proliferates into the vitreous or near the crystal, a yellow light reflection will appear in the pupil area.

Cause

Retinoblastoma.

an examination

Related inspection

Ultrasound examination of the eyeball and eyelid and CT examination of the temporal region

According to medical history, age and clinical symptoms.

X-ray film: calcification point is visible, or the optic nerve hole is enlarged.

B-ultrasound: can be divided into two types of substantive and cystic, the former may be early tumors, the latter represents advanced tumors.

CT examination: (1) high-density mass in the eye: (2) calcification plaque in the mass, 30 to 90% of cases have this finding as a basis for diagnosis; (3) thickening of the optic nerve, enlargement of the optic nerve hole, indicating that the tumor spreads to the brain . Fluorescein fundus angiography: early in the arterial phase, the tumor is fluorescing, the venous phase is enhanced, and it can penetrate into the tumor tissue. Because of the late fluorescence, it is valuable in diagnosis.

Anterior chamber cytology: Our department applied micro-centrifugal precipitator aqueous smear, acridine orange staining, under the fluorescence microscope observation, the tumor cells were orange-yellow, and the positive detection rate was high. It has been used as an indicator for the diagnosis and post-treatment efficacy before photochemotherapy. After long-term observation, no tumor cells were disseminated by corneal puncture wounds.

Urine test: vanilla mandelic acid (VMA) and high vanillic acid (HVA) increased in 24-hour excretion in urinary urine. Therefore, when the VMA and HVA in the urine are positive, it is helpful for diagnosis, but the negative still cannot exclude the tumor.

Determination of the activity of lactate dehydrogenase (LDH): When the LDH value in aqueous humor is higher than the serum median value, the ratio of the two is greater than 1.5, which strongly suggests that retinoblastoma may be.

Other: It can be used for isotope scanning, scleral transillumination, carcinoembryonic antigen and so on.

Differential diagnosis

Differential diagnosis of yellow-white reflective symptoms in the pupil:

The development of retinoblastoma is generally easy to diagnose after the third and fourth stages, but it is more difficult in the first and second stages. During this period, white reflective or yellow-white tissue blocks may appear in the posterior pupil of the lens. (leukoria), in fact, there are many cases of white pupils, which should be noted in the differential diagnosis: abnormal retinal development; post-crystal fibrosis; metastatic endophthalmitis; exudative retinitis (Coats disease): occurred in 7 Male adolescents over -8 years old, mostly single eyes, the progress of the disease is slow. Eye examination, the vitreous is rarely turbid, the retina is white exudative detachment, extensive telangiectasia and bleeding points and cholesterol crystals. The retinoblastoma often occurs in infants under 5 years of age. Vitreous opacity is more common, retinal detachment is solid, and vascular engorgement and new blood vessels are mostly limited to the tumor area. In addition, X-ray photographs, CT and ultrasound diagnosis are significantly different, except for Coats disease.

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