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What Does a White Reflex in a Baby’s Eye Mean?

What Is Leukocoria (White Eye Reflex)?

Leukocoria is the presence of a white or grayish reflection from the pupil, which is normally black. In healthy eyes, the flash of a camera typically produces a red reflex due to the retina’s blood supply. A white glow can be a sign that something is blocking light reflection from the retina.

Possible Causes of White Reflex in Infants

1. Retinoblastoma (Eye Tumor)

  • The most common malignant eye tumor in children
  • Usually occurs before age 5
  • White reflex, misalignment (strabismus), and vision loss are common signs
  • Early detection can save both vision and life

2. Congenital Cataract

  • Clouding of the eye lens present at birth
  • May be due to genetic disorders, infections, or metabolic issues
  • Often associated with strabismus and vision impairment

3. Persistent Fetal Vasculature (PFV)

  • Failure of embryonic blood vessels in the eye to regress
  • Usually affects one eye
  • May cause a small, opaque white spot and impaired vision

4. Retinopathy of Prematurity (ROP)

  • Affects premature babies with abnormal retinal vessel development
  • Can lead to leukocoria in advanced stages
  • Requires laser treatment in some cases

5. Coats Disease

  • Abnormal blood vessel growth in the retina
  • Typically affects one eye
  • Leads to fluid leakage and white reflex over time

6. Intraocular Infections (e.g., Toxoplasmosis, CMV)

  • Infections during pregnancy can damage the baby’s retina
  • May cause scarring and white appearance in the eye
  • Often accompanied by vision impairment

When to Seek Immediate Medical Attention

  • White reflex seen in flash photography (especially in one eye)
  • White, gray, or dull pupil when looking directly
  • Eye misalignment (strabismus) or constant eye movement
  • Baby avoids eye contact or doesn’t track objects

These signs may indicate underlying eye conditions requiring urgent evaluation by a pediatric ophthalmologist.

How Is It Diagnosed?

  • Fundus (retinal) examination with ophthalmoscopy
  • Ocular ultrasound for intraocular masses
  • MRI or CT if structural abnormalities or tumors are suspected
  • Biopsy in rare cases (for retinoblastoma confirmation)

Treatment Options Based on Diagnosis

Condition

Treatment Approach

Retinoblastoma

Chemotherapy, laser therapy, cryotherapy, or eye removal (enucleation)

Cataract

Surgical removal of the lens, artificial lens implantation

PFV / ROP

Laser surgery or vitrectomy

Infections

Antiviral or antibiotic medications, steroids as needed

Parental Guidance and Monitoring Tips

  • Review your baby’s flash photographs for eye reflex
  • Monitor for eye contact and object tracking
  • Ensure both eyes appear symmetrical and equally sized
  • Seek prompt care for any signs of squinting or eye drift

Early detection of leukocoria can prevent vision loss and even save lives in the case of tumors like retinoblastoma.