White glow in a child's eye in photos — what leukocoria means

A white or yellowish reflection from the pupil in flash photographs is called leukocoria. It occurs when light reflects off an abnormal structure behind the lens instead of the normal reddish retina. Common causes include retinoblastoma (a rare eye tumour), dense cataracts, Coats' disease (abnormal retinal blood vessels), and less commonly retinal detachment or persistent fetal vasculature. Leukocoria is not always cancer, but retinoblastoma must be ruled out promptly by an ophthalmologist or paediatric oncologist. Most other causes are also treatable when found early.

No. Leukocoria (white pupil) has several causes, and not all of them are cancer. However, retinoblastoma — a malignant eye tumour — is one of the most important causes and it must be excluded before any other explanation is accepted. Other causes such as cataracts and Coats' disease are treatable but also require prompt medical attention. Because the consequences of missing retinoblastoma are serious, any white pupil reflex in a child should be evaluated by a specialist within days, not weeks.

Retinoblastoma is most commonly diagnosed in children under 5 years of age. About 90% of cases are diagnosed before age 6. It can affect one eye (unilateral) or both eyes (bilateral). The bilateral form tends to appear earlier, often before the child's second birthday. Older children and adults can occasionally develop retinoblastoma, but this is very rare. Early diagnosis — ideally before the tumour grows beyond the eye — is strongly linked to better outcomes and vision preservation.

Yes, you should still seek an evaluation. Leukocoria is often most visible in flash photographs taken at a slight angle, and may not be obvious to the naked eye in normal room light. In early-stage retinoblastoma, the eye may look completely normal to parents during play or conversation. This is one of the reasons why photographs can be an important early-detection tool. If you have seen a white pupil reflex even once in a photo, please describe it to your child's paediatrician and ask for a formal eye examination.

You should contact your paediatrician or an ophthalmologist within a day or two of noticing a white pupil reflex in your child's eye. Do not wait for the next routine check-up if the appointment is weeks away. Retinoblastoma can grow quickly, and earlier evaluation gives specialists more options for treatment. Save the photograph that first showed the white glow — it can be a useful reference during the clinical examination. If your child also has any change in vision, eye crossing (strabismus), or eye redness, the urgency is even greater.

The examining doctor will first check the pupil response and red reflex using an ophthalmoscope or retinoscope. If leukocoria is confirmed, the next step is a dilated fundus examination — eye drops widen the pupil so the doctor can see the retina clearly. In infants and very young children this is often done under a brief general anaesthetic so the child is still and comfortable. If a tumour or other abnormality is suspected, an ultrasound of the eye and an MRI of the orbits and brain may be arranged. These scans do not use radiation. A biopsy of the eye is generally avoided in retinoblastoma because of the risk of spread.