Leukokoria The White Pupil Leukokoria is seen in 50-60% of the patients with retinoblastoma Retinoblastoma is the most common intraocular malignancy in children, usually detected in the primary care clinic (which the ED often is now) Median age of diagnosis: unilateral = 24 months; bilateral = 12 months Metastatic disease: direct extension to CNS, hematogenous to bones, lung, and brain When detected early, it is one of the most curable childhood cancers Untreated, almost all will die within 2 years Refer anyone without a normal red reflex to an ophthalmologist within 1 week. WG Wilson, JR Serwint. Retinoblastoma. Pediatrics in Review. 2007;28:37-38 Melamud A, Palekar R, Singh A Retinoblastoma. Am Fam Physician. 2006 Mar 15;73(6):1039-44.