Leukocoria – White Pupil: Symptoms, Causes, Diagnosis and Treatment

Concept:

Leukocoria literally means “white pupil”, this occurs when the pupil (the circular hole in the center of the iris, through which the rays of light enter the eye) is white instead of the usual black.

In more obvious cases, the pupil is white at all times. In other situations it turns white only in certain circumstances, such as when the pupil enlarges in a dark room.

Sometimes, leukocoria is detected in photographs when one pupil has an abnormal or “white” reflex compared to the other eye that has a normal “red reflex”.

Leukocoria is one of the main signs of retinoblastoma. However, several other conditions can also occur with leukocoria, and it is essential to differentiate retinoblastoma from these so-called pseudoretinoblastomas for proper treatment.

Any patient with an abnormal red reflex should be evaluated quickly by an ophthalmologist. A red reflex examination is also warranted at each pediatric visit from birth to 3 years and, later, as part of the eye exam.

symptom

Leukocoria can be a common sign in various ocular conditions, such as cataracts and vitreous and retinal diseases. It may be characterized by a whitish pupillary reflex that differs from the normal red ocular reflex.

The red ocular reflex appears when a beam of light is focused on the eye through the pupil, the light is partially absorbed and partially reflected by the retina back through the pupil, appearing as a reddish orange reflection that characterizes the color normal of the retina and the choroid.

An early diagnosis is possible with the red reflex test, which reduces the morbidity and possibly the mortality of several ocular conditions.

Causes

A white gleam in the eye, a white pupil, or a white reflex may be a symptom of retinoblastoma, a rare type of eye cancer that affects infants and young children under the age of six.

The medical term for this reflex in the white eye is leucocoria, leuco means white and kore means pupil. In humans it occurs when there is an abnormal light reflection in the eye. It will appear more often in photographs or in low light.

It can be caused by congenital or acquired eye diseases. This is an ophthalmological emergency, particularly due to the need to diagnose and promptly treat diseases such as retinoblastoma, glaucoma, retinal detachment and infections.

Seeing a white glow in your child’s eye can be extremely disturbing, but remember that retinoblastoma is very rare, around 50 cases are diagnosed in the UK each year and there are several other causes of white eye.

But to rule out anything serious, we always recommend that if you detect something unusual, have your child checked by a health professional as soon as possible.

The possible conditions that produce leukocoria or a white glow in the pupil of the eye include:

  • Light that shines on the optic nerve: this is the most common cause of white reflections or white pupils in a photo. The light that enters the eye at a certain angle can be reflected from the optic nerve. This is magnified and you can see the effect of the white eye.
  • Cataract: this is the second most common cause of a white reflex. An opacity that develops on the lens of the eye may appear as a white eye effect on a photo. Surgery can treat this condition.
  • Persistent hyperplastic primary vitreous: the vitreous is the gelatinous substance that is found inside the eye and this condition is due to an embryological disorder that produces a cataract or a retina with scars.
  • Vitreous hemorrhage: small amounts of blood seep into the gelatin in the eye, possibly from a small tear in the retina, which prevents much of the light from traversing the retina and causing a white eye.

If you have seen a white glow in your child’s eye, it is important to have it checked by a health professional (for example, a primary or optician) as soon as possible.

Remember that retinoblastoma is rare and there may be many other reasons for it to appear, but it is better to examine your eyes to rule out anything serious.

Diagnosis of Leukocoria

The ophthalmologist can evaluate a patient who appears to have this symptom, checking a red reflex and collecting other information about the visual appearance of the eye in the process. All this information is diagnostically useful.

It is very important to receive an exhaustive study of leukocoria, since this symptom is usually associated with diseases that are known to cause vision loss or difficulties with visual perception.

Early diagnosis and treatment can give people a better chance of preserving their vision.

The differential diagnosis of leukocoria includes:

  • Abnormalities of the anterior chamber or lens
  • Waterfall
  • Corneal opacity
  • Glaucoma
  • Hypopion (that is, white blood cells that accumulate in the anterior chamber)
  • Congenital anomalies
  • Coloboma of retina, coroids or optic nerve
  • Retinal detachment
  • Folding of the retina
  • Infection
  • Inflammation
  • uveitis
  • Neoplasia
  • Trauma
  • Strange body
  • Retinal detachment
  • Fibrosis retiniana
  • Vascular abnormalities
  • Hemangioma coroideo.

Treatment for Leukocoria

The treatments vary, depending on the conditions that the patient seems to have. Surgery, chemotherapy, medications and radiation are all things that can be recommended to the patient.

People who want a second opinion may want to consider working with a doctor who specializes in the treatment of a given condition to make sure they have access to the latest information about the diagnosis and treatment of the condition.

Doctors who treat retinoblastoma regularly, for example, tend to have better treatment options, as well as better outcomes for the patient.