What Is Leukocoria?

Medically Reviewed by Jabeen Begum, MD on August 24, 2022
4 min read

Leukocoria means "white pupil." It describes a condition where the pupil of the eye is white rather than black. It is more common in children but can occur in adults as well. Many different conditions can cause leukocoria, and all of them should be evaluated promptly by an ophthalmologist. 

Leukocoria is often detected by family members or during routine exams. In more obvious cases, leukocoria symptoms can be detected by looking at an eye under the right lighting. Less obvious cases may become apparent under certain circumstances, such as dim lighting, when the pupil becomes larger. Some cases are discovered when someone takes a flash photograph in a dimly lit room. 

The red reflex occurs when light is reflected off the retina through the pupil. The retina absorbs most light, but the small amount reflected off it appears reddish-orange. The red reflex is what causes "red eye" in flash photography. In people with leukocoria, the red reflex is missing, or the reflected light appears white. 

Many different conditions can cause leukocoria, ranging from minor to life-threatening, so it should always be evaluated quickly by an ophthalmologist. Some possible leukocoria causes include: 

Cataracts. Cataracts occur when you have a cloudy area in the lens of your eye. They're very common as you age and can be easily corrected by surgery. 

Retinal detachment. A retinal detachment occurs when the retina, a thin layer of tissue at the back of the eye, pulls loose from its normal position. There are usually other symptoms accompanying retinal detachment, such as blurred vision, flashes of light, or a shadow over your field of vision. A retinal detachment is an emergency that should be treated immediately.

Endophthalmitis. Endophthalmitis is an infection of the tissues or fluid inside of your eyeball. It can be caused by bacteria or fungi getting inside of your eyeball following an injury or surgery. It can also spread from an infection in another part of your body. Endophthalmitis is an urgent medical emergency that can cause blindness if not treated right away. 

Coats' Disease. Coats' disease is an abnormality affecting the blood vessels inside of your eye. These blood vessels provide blood and oxygen to your retina. Coats' disease causes these blood vessels to become large, twisted, and leaky. The normal flow of blood is prevented, and fluid leaks out of the blood vessels, causing fatty material to build up in the retina. If too much fluid builds up, it can cause your retina to detach. 

Retinoblastoma. Retinoblastoma is a rare form of eye cancer that primarily affects children. Leukococoria is one of the primary symptoms of retinoblastoma. Other symptoms can include poor vision, eye redness or swelling, or eyes that appear to be looking in different directions. 

Retinoblastoma can occur in one or both eyes and spread to other areas of the body such as the brain or spine. There is no known cause of retinoblastoma, although in some cases, a tendency may be inherited.

Power difference. Sometimes, an abnormal red reflex results from a power difference between your eyes. These cases aren't usually serious and are easily treated. 

If a family member or doctor notices leukocoria, you'll be referred to an ophthalmologist for a detailed exam and possibly some other tests. They'll ask questions about your family history, medical history, and symptoms. Your vision will be tested, and your eyes will be thoroughly checked out. 

Depending on the results of your eye exam, your doctor may perform some of the following tests to help determine the cause of your leukocoria: 

Ultrasound. An ultrasound of your eye is a test that uses high-frequency waves to create detailed images of your eye. It's a noninvasive test that can help your doctor diagnose different eye conditions. 

Fluorescein Angiography (FA). This test uses a special camera and fluorescent dye to record the blood flow to your retina. Children with leukocoria will often need an FA. 

Optical coherence tomography (OCT). OCT is a noninvasive test that can detect swelling and fluid in your eyes. It uses reflected light to create an image of the back of your eye.

Magnetic resonance imagery (MRI). An MRI can create detailed images using a large magnet and radio waves. It can be used to evaluate the pineal gland and optic nerve in some patients with leukocoria. 

Blood work. Your doctor may do blood work to diagnose an infection. 

Genetic testing. Genetic testing can help confirm a diagnosis in some cases and can be used for genetic counseling for patients who risk passing on genes that can enable certain cancers. 

Once your doctor is able to diagnose the cause of your leukocoria, the leukocoria treatment will consist of treating the underlying condition causing it. Almost all of the conditions that cause leukocoria can threaten your vision, and some are also life-threatening. Leukocoria should always be evaluated immediately.