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A-Z Glossary

Table of Contents

Leukocoria

Jovi Boparai MD Profile Picture
Written byJovi Boparai, MD
Jovi Boparai MD Profile Picture
Jovi Boparai, MDCo-founder & CEO of CorneaCarePhiladelphia, PA

Bio

Dry eye disease is tough! I get it. I have struggled with dry eyes for several years from contact lens use, and from spending countless hours looking at computer screens. In college, my dry eyes got so bad that I couldn’t wear contact lenses, because of a constant “foreign body sensation” when I had them in. I had to stop reading every 30 minutes because my eyes would start to burn and my vision would get blurry. I tried a plethora of treatments and nothing seemed to work. Dry eye disease was not only impacting my eyes, but also my emotional wellbeing. It was preventing me from enjoying life, and getting in the way of my professional training. I felt overwhelmed, frustrated and hopeless.

It was only when I realized that my dry eyes were linked to my lifestyle, environment and overall health did things start to make sense. I noticed that on days when I spent less time on the computer, my eyes felt better. My symptoms would flare when it was windy, or when there was low humidity. I knew that if I wanted to get ahead of my dry eyes, I needed to not only treat my eyes, but to also address my lifestyle. I started a consistent regimen of artificial tears and eyelid hygiene. I switched from monthly contact lenses to daily contact lenses. I started taking scheduled breaks from looking at a computer. I ate a healthier diet focused on anti-inflammatory/antioxidants foods, and I bought a humidifier for my room. In the beginning doing all this seemed impossible, but over time it became part of my usual routine. Not only did my eyes feel better, but I was overall healthier and happier! Turns out what is good for my eyes, was also good for my mind and body. I carried this lesson with me as I started my career to become an ophthalmologist and ophthalmic surgeon.

Because of my personal journey and professional training, I believe dry eye treatment starts by listening to and empowering the patient. I listen for the struggles and cue in on their strengths, while picking up on their lifestyle. Only then do we together start building a treatment plan that incorporates good eye hygiene with small, but impactful lifestyle changes. Our sight is our most important sense, and it is intimately linked to our very being. I want dry eye patients to not only get their dry eyes under control, but to also enjoy good mental and physical health, and live a fulfilling life. What is good for the eyes should also strengthen the mind and fortify the body!

Get to know me a little better!

Hobby: vintage watches
Food: peanut butter
Superhero: Superman
Guilty pleasure: desserts
Secret power: has never had a headache

Training:

Undergraduate: University of Pittsburgh Honors College
Medical school: Weill Cornell Medicine
Ophthalmology residency: Wills Eye Hospital.

  • Last updated December 15, 2022

What is Leukocoria?

Leukocoria means “white pupil,” and is characterized by the presence of white light reflected off the back of the eye.  This white reflection can be seen when you look directly into a bright light source, such as a camera flash.

Typically, you see a red-eye effect on photos taken with a flash, but with leukocoria, the pupil appears white. Leukocoria is most often seen in people who have an eye disease or when there is damage to the back of the eye. Therefore prompt diagnosis and treatment are essential. 

Key Points 

  • Leukocoria means “white pupil” which is noticeable when someone looks at a bright light source.
  • Adult leukocoria could be a sign of a cataract or another eye problem.
  • Leukocoria is a symptom of several diseases, such as Coats disease, congenital cataract, corneal scarring, and ciliary body melanoma.
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Understanding Leukocoria

The red reflex describes the reddish-orange light reflection from the fundus. You may be able to appreciate this when looking at old photos where the eyes appear “red.” The red is abnormal if there is asymmetry between the eyes, black blotches, or a white reflex (leukocoria).

The retina absorbs light that enters the eye through the pupil, but also reflects some which exits the eye through the pupil. This reflected light has a reddish-orange tint that resembles a healthy retina. When the eye is parallel to the light source, the “red reflex” is most readily visible. 

With leukocoria, the red reflex is either nonexistent or appears white. Pediatricians will refer patients who exhibit an “abnormal red reflex” to an eye doctor for a complete eye exam. Primary care providers will do the same in adults.

How to Detect Leukocoria

When the white pupil is very visible, you can see it just by looking into the eye in ideal lighting. In other cases, the pupil may only appear white under specific conditions, such as when the pupil enlarges in a dim environment or when the person is looking in a specific direction.

Sometimes a photo taken with a flash camera can highlight the white pupil in children and adults. A pediatrician can discover leukocoria during a regular visit. Specifically, when the doctor uses an ophthalmoscope to examine the eyes or a portable visual acuity and red reflex machine.

What Causes Leukocoria?

There are several disorders that may cause leukocoria. These include cataracts, retinal detachments, retinopathy of prematurity, endophthalmitis, abnormalities of the retinal blood vessels (such as Coat’s disease), and intraocular tumors (retinoblastoma). The presence of leukocoria always warrants a dilated exam with an eye doctor.

Symptoms Of Leukocoria

In adults with leukocoria, symptoms will reflect the underlying cause of the white pupil. For instance, with cataracts, adult patients may also complain about blurry vision and glare. With retinal detachment, patients may experience flashes, floaters, and a “curtain-like” sensation over their vision.

In children, the symptoms are subtle and not easily detected, which is why screening is so important. Depending on how long a child has had leukocoria, their affected eye may not line up with their good eye (strabismus), or the child tilts her head to use the good eye for seeing.

Diagnosis

A red reflex exam is an important health check that should be performed on all infants during their first two months of life, and periodically thereafter. This exam allows pediatricians to determine whether the infant has any vision problems and can help to plan treatment. Conducting this examination in a darkened room, preferably voluntarily, using a direct ophthalmoscope held close to the infant’s eyes is the best way to ensure accuracy and precision.

Doctors use the same diagnostic process in adults.

Treatment

It is critical your child visit an eye doctor as soon as leukocoria is suspected. It requires urgency. Recommended treatment will depend on the underlying cause of the leukocoria.

In adults, cataract surgery is recommended when cataracts are the cause of leukocoria. In children, tumor surgery and chemotherapy may be recommended when retinoblastoma is the cause.

Bibliography

  1. “Leukocoria – American Association for Pediatric Ophthalmology and Strabismus.” Aapos.org, aapos.org/glossary/leukocoria.
  2. “Leukocoria.” Wikipedia, 22 Mar. 2022, en.m.wikipedia.org/wiki/Leukocoria. Accessed 3 Aug. 2022.
  3. “Detecting Leukocoria: What to Know.” Verywell Health, www.verywellhealth.com/leukocoria-5218867. Accessed 3 Aug. 2022.

Related Terms

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Episclera

is a fibroelastic structure consisting of two layers joined together loosely. It is the white of the eye

Dermatochalasis

describes the presence of loose and redundant eyelid skin. It is most often caused by aging

Chemosis

is the swelling of the conjunctiva, which is the clear membrane over the eyelids and the surface of the eye

Pupillometer

is a device that measures the distance between the pupils. The device is used when you order new eyeglasses

Spatial Frequency

describes the rate that a stimulus changes across space. It is usually measured with black and white line gratings

Macula Lutea

also known as the macula, refers to the small area in the back of the eye that is responsible for central vision

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