May 18, 2015 Post By: Children's Health

Watch Out for White Eyes in Photos
Daddy blogger discusses leukocoria or “white pupil” that sometimes appears in photographs and interviews a pediatric ophthalmologist on what this can mean.

As the only grandchild on her mother’s or father’s side, Emmy has been the focus of at least a thousand photos in her six months. So, if it’s true that each picture says a thousand words, her pictures have said around a million.

Adorable. Cute. Blue-eyed. Big smile. Playful. Those words are certainly expressed in the images I scroll through daily on my phone. But cancer? Cataracts? I was worried a couple of weeks ago that her pictures may be saying those words, too.

There’s an effect called leukocoria that every parent should look for in their child’s photos. It literally means “white pupil.” And it looks like a deer’s eyes when they meet brights on a rural highway.

It should concern parents because it can be a sign of a retinoblastoma (a lethal tumor inside the eye), cataracts and other serious eye diseases. I wrote a story about it several years ago and knew to look for it when I had my own child.

Emmy had several photos with the white-eye reflex during her first couple of months. They didn’t concern us too much because there were also several normal red-eye photos of her interspersed. Besides, she showed no sign of anything being wrong.

Then, a couple of weeks ago, my wife, Meredith, sent me the above photo of Emmy where both of her pupils are white. I got nervous. And, as all wise people do, I proceeded to look up everything I could find about it on the Internet.

What bothered me most was that all of the conditions associated with leukocoria are asymptomatic, meaning no symptoms are evident until diagnosis or it’s too late. The only semi-reliable way to tell if your child has those conditions is the photograph test.

Since Emmy didn’t pass that, I really started to worry. Really. My wife said I was paranoid, that my job makes me ripe to fear my child has every disease that I write about. And she had a point. But I felt like this was too serious to ignore. So, I spoke with one of our experts.

Why doctors are better than the Internet

Dr. Alison Smith, an ophthalmologist at Children’s, agreed with Meredith that the chances of Emmy having a retinoblastoma, even after having the white-eye reflex, were minute.

“Chances are the white-eye reflex is not a sign of retinoblastoma,” she said. “It’s the one everyone hears about because it’s the worst. But it isn’t nearly the most common cause for the reflex.”

Up there with the most common causes of leukocoria, she added, are bad photography angles. Think of a pupil like a hollow tube. If someone without any eye irregularities is looking directly at the camera, her eyes will flash red because the flash illuminates straight through the tube of the pupil all the way back to the red optic nerve. On the other hand, if she is looking away from the camera, the flash will enter the tube at an angle and illuminate the white insides of the eye.

That said, determining whether a bad angle caused the white-eye reflex is difficult for an expert to do just by looking at a photo. So, it’s nearly impossible for a layman like me to do. On top of that, other possible causes like cataracts or Coat’s Disease worsen the longer they’re unidentified.

That’s why, per Dr. Smith’s advice, we took Emmy to have an eye exam at her pediatrician’s. “I don’t think it’s overreacting at all to contact your pediatrician as soon as you notice the white-eye reflex,” she said. “Eye exams are very benign and non-invasive. They give you peace of mind and aren’t that big of a deal.”

Emmy’s pediatrician examined her eyes – as he and most pediatricians do at every checkup –and assured us that he saw no evidence of retinoblastoma, cataracts, Coat’s Disease or any of the other conditions associated with the white-eye reflex. It took about 10 minutes total. And, like Dr. Smith said, I got peace of mind.

“I guess the bottom line is that taking a picture is a good screening exam by parents but the ultimate test is having your pediatrician look at your child and then determine whether or not she needs to see a specialist,” Dr. Smith said.

So, keep taking photos of your little one. If you see a picture with the white-eye reflex, don’t assume he has cancer or cataracts like this paranoid writer did. Just take him to the pediatrician.