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 may see the red-eye effect on photos taken with a flash, but with leukocoria, the pupil appears white. Leukocoria is most commonly 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 Takeaways
- 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.
Understanding Leukocoria
The red reflex is the term used to describe 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 regarded as abnormal if there is any 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” during the examination to an eye doctor for a complete examination. Primary care providers will do the same in adults.
How Is Leukocoria Detected?
When the white pupil is very visible, it can be seen by just glancing 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 in children, a photo taken with a flash camera can highlight the white pupil, and the same may be true in adults. Leukocoria can also be discovered during a standard pediatrician visit, specifically when the doctor uses an ophthalmoscope to examine the eyes or a portable visual acuity and reflex reflex machine.
What Causes Leukocoria?
Leukocoria can be brought on by several disorders, such as 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 for full evaluation.
Symptoms Of Leukocoria
In adults with leukocoria, symptoms will typically 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 endorse 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 examination is an important health check that should be performed on all infants during their first two months of life, and periodically thereafter. This examination allows pediatricians to determine whether the infant has any vision problems and can help to plan any necessary therapies. 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. The same diagnostic process can be used in adults.
Treatment
Once leukocoria is suspected or diagnosed, it warrants an immediate referral to an eye doctor for evaluation. The urgency of referral cannot be stressed enough in children. The treatment will depend on the underlying cause of the leukocoria. In adults, cataract surgery may be recommended if cataracts are the cause of leukocoria. In children, tumor surgery and chemotherapy may be recommended if a retinoblastoma is the cause.
