Leukocoria

What is leukocoria?

Leukocoria is when the reflected light in the pupil of your eye appears white, gray, silvery or yellow instead of red. The name of this symptom comes from Greek and means “white pupil.” It’s also sometimes called “cat’s eye pupil.” Leukocoria may signal a serious problem within your eye.

When someone shines a light at your eyes, it should cause a faint red reflection in your pupil. That’s called the “red reflex,” and it happens because of light bouncing off the retina at the back of your eye. A common way to see this is by taking a flash-illuminated picture of someone looking directly at you.

If something else is in the way and reflects the light instead of the retina, that can cause leukocoria. This symptom mainly affects children, but it can also happen in adults. But the conditions that usually cause it in adults aren’t as likely to be dangerous.

Is leukocoria serious?

Noticing a white pupil in a photo of your child might seem concerning based on the above description. But it’s important to remember that a single photo with a white reflection in the pupil isn’t a cause for fear or panic.

The surface of your eye can also reflect light, and sometimes that can cause an effect that resembles leukocoria but isn’t the same. Leukocoria fills most or all of the pupil. A surface reflection is usually smaller and won’t appear in the same location in different photographs.

If you’re concerned about possibly seeing leukocoria in a photo, try taking additional pictures. You should take pictures from different angles (above, below, left, right). If a leukocoria-like reflection appears in multiple photos and the color difference fills the entire pupil, you should ask your child’s pediatrician or other provider for an appointment as soon as possible.

What are the most common causes of leukocoria?

In children, the two most common causes of leukocoria are:

• Cataracts. These can be present at birth (congenital) or develop during childhood (pediatric). They make up about 74% of leukocoria cases in children. One-sided cataracts are usually sporadic, meaning they happen on their own. Cataracts in both of a child’s eyes usually indicate another condition like Stickler syndrome or galactosemia.
• Retinoblastoma. This is a cancer of the retina. In rare cases, children can develop a retinoma (a noncancerous growth similar to retinoblastoma) and then have that retinoma turn into retinoblastoma later as adults.

The following conditions each account for about 1% of childhood leukocoria cases:

• Retinal detachment.
• Retinopathy of prematurity.
• Persistent pupillary membrane.

Other causes (which are even rarer) include:

• Persistent fetal vasculature (PFV) or persistent hyperplastic primary vitreous (PHPV).
• Endophthalmitis.
• Coloboma.
• Familial exudative vitreoretinopathy (FEVR).
• TORCH infections (infectious diseases that a fetus can contract from the parent carrying it or that a baby can contract from a birthing parent during birth).
• Astrocytic hamartomas (benign growths).
• Coats disease.

How is this leukocoria treated?

The treatment for leukocoria depends greatly on what the cause is. Most causes are treatable, but some are serious enough that they usually involve removal of part or all of the affected eye.

• Cataracts: Congenital or pediatric cataracts are the most common cause of leukocoria and are also one of the most treatable leukocoria causes. Cataract surgery in children is virtually the same as in adults. It involves removing the eye’s cloudy lens and replacing it with an artificial lens.
• Retinoblastoma: The specific treatment for retinoblastoma depends on the tumor’s exact location, its size, what structures around the retina it affects, and more. Treatment can involve chemotherapy, radiation therapy, cryotherapy or thermotherapy — or a combination of these methods.

The treatments vary widely for rarer conditions that can cause leukocoria in children. Your provider (or your child’s provider) can tell you more about the specific treatment(s) that may help and which they recommend.

When should this symptom be treated by a doctor or healthcare provider?

Leukocoria always needs to be evaluated by an eye specialist because of the risk of it being a symptom of retinoblastoma. Often a healthcare provider like your child’s pediatrician will be the first to notice it.

But loved ones might also see it when taking pictures of children. If you think you see leukocoria in a picture, try taking more.

A note from Cleveland Clinic

You might not think about the color of reflected light in your or your child’s eyes in a photo. But if you do, you may want to pay attention. A single photo with an eye that reflects gray, white, silver or yellow light isn’t cause for alarm. But if you notice it happening in multiple photos, talk to your provider (or your child’s provider).

Most cases of leukocoria happen because of conditions that affect vision but aren’t dangerous. But about 1 out of 5 childhood cases involve a cancer called retinoblastoma. In those cases, early diagnosis and treatment can make a difference in the survival and use of the affected eye.