Pediatric Leukocoria

Specialists in North Texas

When you first notice a white or unusual reflection in your child’s eye, it can be a source of deep concern and uncertainty. This sign, known as leukocoria, can indicate a range of eye conditions, from the more common, like cataracts, to serious ones, such as retinoblastoma. Early detection is crucial in managing these conditions effectively, which is why it’s essential to seek expert care immediately. At Pediatric Eye Specialists, we understand the anxieties you face as a parent and are committed to providing compassionate, comprehensive care.

Expert Pediatric Leukocoria Treatment for North Texas

Our team at Pediatric Eye Specialists is dedicated to being your trusted ally in this journey. We specialize in pediatric ophthalmology and utilize advanced diagnostic methods, including magnetic resonance imaging (MRI) and B-scan ultrasonography, to accurately identify the cause of leukocoria. By offering personalized treatment plans and supporting your family through every step, we ensure the best possible outcomes for your child’s vision and overall health. You’re not alone in this; we’re here to guide, support, and deliver the expert care your child needs.

Dr. Norman with patient

The Basics: What is Pediatric Leukocoria?

Pediatric leukocoria is a medical sign in children characterized by an abnormal white reflection inside the pupil of the eye. Unlike the typical red reflex seen when light shines into the eye, leukocoria can indicate the presence of serious eye diseases such as retinoblastoma (a type of eye cancer), congenital cataracts, or a retinal detachment from a variety of causes. This condition is often first noticed in photographs, where one or both of the child’s pupils appear white instead of red. Early detection and treatment of the underlying causes of leukocoria are crucial, as they can significantly impact visual development and overall eye health. The causes of leukocoria are broad. While we do strongly recommend that a family with a child diagnosed with leukocoria schedule an appointment with haste, we also want families to remember that this is frequently misdiagnosed and some causes of a visualized leukocoria by a pediatrician or parent are relatively harmless compared to others. Pediatric leukocoria demands prompt medical attention and a comprehensive evaluation by pediatric eye care specialists to determine the appropriate course of action.

Why Choose Pediatric Eye Specialists for Pediatric Leukocoria

The Most Experienced Team in North Texas

With over sixty-five years of collective pediatric ophthalmology expertise, we offer your child unparalleled collaborative care.

Four Convenient Locations

Easily accessible care with offices in Fort Worth, Denton, Southlake, and Mansfield, with expansion into Prosper in the near future. 

Unrushed, Clear Communication

We take the time to discuss your child's diagnosis and treatment, ensuring all your questions are answered to ease your concerns.

Affiliated with Cook Children’s Hospital

Our partnership with Cook Children’s Hospital means if your child needs surgery, imaging, or other specialists, they will be treated in one of the nation’s leading pediatric hospitals.

Specialized Expertise

Our expertise means that more optometrists, doctors, and specialists refer their pediatric eye patients to Pediatric Eye Specialists than any other pediatric eye practice in North Texas. 

Child and Family Focused​

Kids love us, and we love kids! We provide a caring environment for your child and your family.

Advanced Diagnostic Technology

We have the most comprehensive pediatric diagnostic suite in North Texas, allowing for precise diagnosis and highly personalized treatment plans. 

Every Child Needs Access to Expert Eye Care

Championing the right to sight, we help navigate insurance, cash pay, and Medicaid options to make superior eye care feasible for all children regardless of their socioeconomic status.

Dr. Packwood with patient

Benefits of the Early Treatment of Leukocoria

Early treatment of pediatric leukocoria is essential for protecting your child’s vision. Addressing this condition promptly can prevent more severe complications such as vision loss and help maintain your child’s visual function.

Success You Can Expect for Your Child

Improved Visual Outcomes

Early intervention in cases of pediatric leukocoria is crucial for better visual prognosis. Addressing this condition as soon as it's detected can significantly enhance the chances of preserving and improving your child's vision, preventing complications like strabismus (crossed eyes), and ensuring better visual function and health.

Early Detection of Serious Illnesses

Perhaps one of the most significant benefits of early treatment for pediatric leukocoria is the potential for early detection of more serious illnesses. Conditions like retinoblastoma (a type of eye cancer) and other serious disorders can initially present as leukocoria. Early detection and treatment of these conditions can be lifesaving and may significantly improve the prognosis. By addressing leukocoria promptly, we not only focus on preserving vision, but also focus on the overall health and well-being of your child.

Comprehensive Management

Early treatment allows for a thorough management of the underlying causes of leukocoria, which can range from infections and inflammation to serious conditions like tumors or retinoblastoma. By initiating treatment promptly, we can address not only the visible symptoms, but also the root causes, providing a more effective and holistic approach to your child’s eye health.

Support for Development

Vision is a critical component of a child's developmental process. Leukocoria, if not treated early, can impede visual development, affecting learning and other social interactions. Early and appropriate intervention is essential to ensure that children reach their developmental milestones and can engage fully in learning and social activities.

Empowering Parents

We understand the importance of providing parents with the knowledge and resources necessary to make informed decisions. Our team is dedicated to educating and involving you in the treatment process, ensuring that you feel supported and confident in the care your child receives.

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Causes of Pediatric Leukocoria

Pediatric leukocoria, characterized by an abnormal white reflection from the retina, can be a sign of various underlying eye disorders, some of which are serious and require immediate attention. Understanding these causes is crucial for effective diagnosis and treatment. While we do strongly recommend that a family with a child diagnosed with leukocoria schedule an appointment with haste, we also want families to remember that this is frequently misdiagnosed and some causes of a visualized leukocoria by a pediatrician or parent are relatively harmless compared to others.


This is the most feared cause of leukocoria. Retinoblastoma is a childhood cancer that can initially have no symptoms other than the sign of leukocoria. It presents as a tumor inside the eye, but can eventually be life-threatening. We would check for retinoblastoma with a dilated eye examination and, occasionally, the use of an ocular ultrasound called a B-Scan. Without a family history of retinoblastoma, this condition is relatively rare.

Congenital Cataracts

One of the more common causes of a true pediatric leukocoria, a cataract is when the lens of the eye is cloudy instead of clear, blocking light from reaching the retina and leading to a whitish glow in the pupil. Some children can be born with cataracts. Cataracts threaten visual development, thus must be treated urgently to prevent blindness, however, these are not life threatening.

Retinopathy of Prematurity (ROP)

Common in preterm births, ROP is a disease where there is incomplete vascularization of the retina and abnormal blood vessel growth can cause problems inside the eye. If an infant had a complication of his or her retinopathy of prematurity, he or she might have developed a retinal detachment. Thankfully due to new treatment methods and screening guidelines in place, this is more rare than in the past. However, a retinal detachment could cause a white appearing reflex inside the eye (leukocoria).

Coats' Disease

This rare condition is characterized by abnormal blood vessel development in the retina, leading to blood and fluid leakage that can cause retinal detachments. Coats’ disease is a nonhereditary eye disorder marked by a gradual decrease in vision and is more common in males. This condition can cause leukocoria due to the presence of cholesterol deposits from the leaking vessels reflecting light abnormally and causing a white reflex, or by the a retinal detachment causing the white reflex.

Persistent Fetal Vasculature (PFV)

Formerly known as persistent hyperplastic primary vitreous, PFV occurs when the normal embryologic vasculature in the eye, the network of blood vessels that form naturally as the baby develops in the womb, fails to regress, leading to an abnormal connection between the lens and the retina. This can cause a range of issues, including cataracts and retinal detachments. In the simplest terms, baby eyes grow lots of temporary small blood vessels. The ones that aren’t needed are supposed to disappear, but sometimes they don’t. When these leftover vessels don’t go away on their own, the eye can occasionally have problems. Some of these problems can cause the appearance of leukocoria.

Other Causes

Other causes of pediatric leukocoria include conditions like familial exudative vitreoretinopathy (FEVR) (which affects the growth and development of blood vessels in the retina), a retinal coloboma (a condition where part of the retina is missing), endophthalmitis (an infection of inside the eyeball typically a result of trauma or a prior procedure), a myelinated nerve fiber layer (retinal nerve fibers that have a myelin sheath, ie. part of the retina appears whiter than expected), melanoma, Toxocariasis (an intraocular infection from a round worm that is common to cats and dogs), or Incontinentia pigmenti (a genetic condition associated with skin and eye findings).


Certain conditions can give an abnormal reflex of the eye that appear white, yellow, or dark red, but are not true causes of leukocoria. Strabismus (or misalignment of the eyes) can cause one eye to give a different reflex than the other due to an eye’s crossing inwards or its outward deviation. Large glasses prescriptions of an eye can cause dim reflexes, than can be concerning for a possible leukocoria until evaluated by a pediatric ophthalmologist. Uneven glasses prescriptions (such as one eye having a high prescription and the other eye being in the normal range) could be concerning for a pediatrician and be called leukocoria.

It’s essential to recognize that leukocoria can be a symptom of several diseases, and a comprehensive medical diagnosis by a pediatric ophthalmologist is necessary for proper identification and treatment. At Pediatric Eye Specialists, we utilize advanced diagnostic methods to identify the underlying cause of leukocoria. This allows us to provide an accurate diagnosis and create a tailored treatment plans for each child, ensuring the best possible outcomes for their visual health.

Understanding these causes is vital for Pediatric Eye Specialists in diagnosing and formulating an effective treatment plan for leukocoria.

Signs and Symptoms of Leukocoria in Children

Identifying the signs and symptoms of pediatric leukocoria is crucial for early detection and effective treatment. Leukocoria can manifest in various ways, and understanding these key indicators is vital for parents and caregivers. Here are the common signs and symptoms associated with this condition:

White Pupil

By definition, leukocoria is a white or off-white reflection in the pupil, which is typically noticeable in certain lighting conditions or photographs where a flash is used. Instead of the normal red-eye effect, the pupil may appear white or yellowish. This abnormal reflection is caused by an opacity in the eye, which could be due to a cataract, retinoblastoma, or other conditions that can cause leukocoria.

Vision Changes

Depending on the underlying cause, children with leukocoria might experience vision changes. This could manifest as difficulty focusing, poor visual tracking, or an apparent lack of visual responsiveness in infants. In older children, you might notice them struggling to see objects at a distance or having trouble with activities that require sharp vision.

Strabismus (Crossed Eyes)

Sometimes leukocoria can be accompanied by strabismus, where the eyes do not align properly. One eye may appear to wander inward or outward, which could indicate poor vision in an eye.

Nystagmus (Uncontrolled Eye Movements)

In some cases, children with leukocoria may develop nystagmus, characterized by uncontrolled and repetitive eye movements. This symptom can be a response to impaired vision and may occur in various types of eye disorders.

Pain or Discomfort

Although not as common, some children may experience pain or discomfort in the eye. This could be a sign of increased pressure within the eye or inflammation, and it warrants immediate medical attention.

Photophobia (Light Sensitivity)

Increased sensitivity to light or photophobia is another symptom that can accompany leukocoria. Children may squint or become distressed in bright light, indicating potential issues with the eye’s internal structures.

What Parents Report

Parents often tell us this in regard to their leukocoria concerns.

  • “There’s a strange white glow in my child’s pupil.”
  • “The black part of her eye looks white instead of black.”
  • “I’ve noticed a white reflection in his eye when light shines on it.”
  • “When I take pictures with the flash, one of his eyes shines brightly back instead of being dark.”
  • “Under certain lighting, her pupil loses its black color and looks milky.”

Still Have Questions?

Recognizing these signs and symptoms early on and consulting with a pediatric ophthalmologist can lead to a timely and accurate diagnosis. At Pediatric Eye Specialists, we encourage parents to seek medical advice if they notice any of these symptoms in their child. Early detection is key in managing pediatric leukocoria effectively and ensuring the best possible outcomes for your child’s vision and overall eye health.

Diagnosing Pediatric Leukocoria

The process of diagnosing pediatric leukocoria is intricate and requires a series of specialized tests to accurately identify the underlying cause. Pediatric Eye Specialists utilizes a combination of advanced diagnostic procedures to ensure a comprehensive assessment of this condition.

Red Reflex Test

This initial screening is often the first step in detecting leukocoria. The red reflex test involves using an ophthalmoscope to shine a light into the child’s eyes. In healthy eyes, the reflection appears red. An abnormal white reflection, known as leukocoria, may indicate the presence of an underlying disorder.

Dilated Eye Examination

Frequently, by dilation of the pupil, the ophthalmologist can look at the retina in your child’s eye and determine the cause of the leukocoria. Sometimes that lack of a view into the eye (such as the presence of a cataract) leads to further testing for a diagnosis.


When leukocoria is observed, an ocular ultrasound (ultrasound of the eye) is often performed. This noninvasive test uses high frequency sound waves to create images of the eye’s internal structures. It helps in identifying abnormalities such as retinal detachment, tumors like retinoblastoma, or other structural anomalies associated with leukocoria.

Fluorescein Angiography

In certain cases, fluorescein angiography is conducted to examine the blood vessels in the retina. This procedure involves injecting a fluorescent dye into the bloodstream, which illuminates the blood vessels in the back of the eye. It is particularly useful in identifying conditions like Coats’ disease, where abnormal retinal blood vessel development is a key concern.

Additional Diagnostic Tools

Depending on the suspected underlying condition, other diagnostic methods may include magnetic resonance imaging (MRI) and CT scans for detailed imaging when suspecting conditions like retinoblastoma.

The process of diagnosing pediatric leukocoria at Pediatric Eye Specialists is thorough and patient-centric. Each step is taken with utmost care to ensure the child’s comfort while providing accurate and detailed information to guide treatment decisions. Early and precise diagnosis is key in managing leukocoria effectively, and our team is committed to utilizing the best resources available to achieve this.

Pediatric Leukocoria Treatments

Treating pediatric leukocoria involves a range of strategies, tailored to address the specific underlying cause of this symptom. At Pediatric Eye Specialists, our approach is holistic, combining state-of-the-art medical interventions with compassionate, child-focused care. Here’s an overview of the treatment options we offer for various conditions associated with pediatric leukocoria:

Medication for Retinopathy

In cases where leukocoria is caused by retinopathy of prematurity (ROP) or other retinal diseases, specific medications may be used. These could include anti-VEGF (Vascular Endothelial Growth Factor) drugs, which are injected into the eye to control abnormal blood vessel growth. This treatment is particularly effective in managing diseases like ROP, where excessive vascular proliferation is a concern.

Laser Therapy

For conditions like Coats’ disease, which involves abnormal blood vessel growth in the retina, laser photocoagulation therapy is often utilized. This treatment involves using a laser to seal off leaking blood vessels and prevent further fluid accumulation, thereby reducing the risk of retinal detachment.

Surgical Intervention

In more severe cases, such as when leukocoria is due to a cataract or retinoblastoma, surgical intervention might be necessary. Cataract surgery involves the removal of the cloudy lens and, in some cases, the placement of an intraocular lens. For retinoblastoma, treatment may include enucleation (removal of the eye) in advanced cases, or eye-sparing techniques like cryotherapy, thermotherapy, or chemotherapy, depending on the tumor’s size and location.

Systemic Treatments:

In some cases, systemic treatments like chemotherapy may be required, especially in conditions like retinoblastoma. Chemotherapy can be administered locally (directly into the eye) or systemically, depending on the extent of the disease.

Follow-up and Monitoring

Regular follow-up and monitoring are crucial components of treatment for pediatric leukocoria. This ongoing care helps in assessing the effectiveness of the treatment, monitoring for potential recurrence, and ensuring the overall health of the child’s eye.

Supportive Therapies

In addition to medical treatments, supportive therapies such eye glasses may be recommended, especially if the child’s vision is affected. These therapies are aimed at maximizing visual function and improving the child’s quality of life.

At Pediatric Eye Specialists, we understand that a diagnosis of leukocoria can be daunting for both the child and their family. Our team is committed to providing comprehensive care and support throughout the treatment process. We work closely with families to ensure they are fully informed and comfortable with the treatment plan, offering the latest medical advancements combined with a compassionate approach to care.

Our commitment at Pediatric Eye Specialists is to provide your child with the highest standard of care, combining medical expertise with compassion and understanding.

Typical Expected Outcomes for Pediatric Leukocoria

When it comes to pediatric leukocoria, the prognosis and expected outcomes following treatment can vary significantly based on the underlying cause, the severity of the condition, and the timeliness of the intervention. Pediatric Eye Specialists prioritizes early detection and intervention, which are crucial for achieving the best possible outcomes. Here, we outline the general expectations following treatment, always ensuring that our approach is grounded in realism and medical accuracy:

Retinopathy of Prematurity (ROP)

For cases of ROP, early intervention typically results in positive outcomes, especially when treated in the milder stages. Advanced ROP can lead to more serious complications, including retinal detachment. However, with timely laser therapy or anti-VEGF treatments, many children can maintain or achieve improved vision.

Coats' Disease

The outcome of Coats’ disease treatment largely depends on the stage of the disease at diagnosis. Early-stage Coats’ disease, when treated with laser photocoagulation, often has a favorable outcome with stabilization or improvement of vision. In more advanced cases, where a retinal detachment has occurred, the prognosis might be less optimistic, and the goal of treatment may shift towards preserving the eye and preventing further deterioration.

Congenital Cataract

With early surgical intervention, children with leukocoria due to congenital cataracts can often achieve good visual outcomes. Post surgery, the use of corrective lenses or intraocular lens implants, along with visual rehabilitation, can significantly improve vision. It’s important to note that early treatment is key to preventing amblyopia (lazy eye), a common complication of untreated cataracts in children.


The prognosis for retinoblastoma depends on the size and location of the tumor, as well as whether it has spread beyond the eye. With early detection and treatment, the survival rate is high, and in many cases, vision can be preserved.

Persistent Fetal Vasculature (PFV)

The outcome for children with PFV varies. In mild cases, vision can be preserved or improved with surgery. In more severe cases, where there is significant impact on the eye’s structures, the focus may be on managing the condition and maximizing the child’s functional vision.

It’s important for parents to understand that while early intervention can lead to more positive outcomes, each child’s situation is unique. Our team at Pediatric Eye Specialists is committed to providing honest and clear communication about the prognosis and expected outcomes. We ensure that families are informed and supported throughout the treatment process, helping them to set realistic expectations and achieve the best possible results for their child.

Ensure Your Child's Bright Future: Schedule Your Child's Leukocoria Consultation Today

If you’ve noticed signs of leukocoria in your child, don’t wait to seek expert care. Early detection and treatment are key to managing this condition effectively. At Pediatric Eye Specialists, our team of compassionate and skilled pediatric ophthalmologists and optometrists are here to guide you through every step of your child’s journey towards better eye health. Book an appointment with us today and take the first step in ensuring a brighter future for your child. Your peace of mind and your child’s vision are our top priorities.

Doctor and Patient

Start your child’s journey to better vision today.

Embrace a future of clearer vision and confidence for your child. Contact us now to book your consultation at any of our convenient locations across the Metroplex.

Does leukocoria mean my child is going to lose their sight?

No, leukocoria can be caused by different things, some more serious than others. The best step is to get an eye exam by a specialist who can figure out why it’s happening and talk about the best treatments to protect your child’s sight.

Why does my child’s eye look different in pictures with a flash?

When a flash is used in photos, it can cause an effect called the “red reflex,” which is normal and causes the pupils to look red. If your child’s eye looks white or has white spots in photos with a flash, it could be due to leukocoria. It’s a sign you should have an eye doctor check your child’s eyes to make sure everything is okay.

Will my child need surgery for leukocoria?

It depends on the cause of the leukocoria. Some conditions leading to leukocoria may require surgery, while others can be treated with medication or may even resolve on its own. A specialist at Pediatric Eye Specialists can help determine the best course of action after examining your child.

Are other children in my family at risk for leukocoria?

Leukocoria can be caused by different issues, some of which may be genetic. If your child has leukocoria, it’s a good idea to have their siblings’ eyes checked as well. Most cases are isolated, but an eye doctor can help you understand if there’s a risk to other family members.

Is leukocoria something that babies are born with?

Leukocoria can be present at birth, or it might develop later on. It’s not always something a baby is born with. Sometimes it can be due to an eye injury or an infection that happens after birth.

Can leukocoria be cured?

The treatment for leukocoria depends on what’s causing it. In many cases, the conditions that lead to leukocoria can be treated, especially if found early. That’s why it’s really important to see an eye specialist if you think something might be wrong with your child’s eyes.

Could leukocoria indicate a need for emergent medical attention due to conditions like endophthalmitis?

In some cases, leukocoria can signal serious conditions such as endophthalmitis, which is an inflammation inside the eye often related to infection or injury. This requires immediate medical evaluation and possibly emergent care to prevent further complications like severe visual impairment. If your child has leukocoria and also has a very red and painful eye, this would be an indication to consider going to an emergency room or seeing us within 24 hours.

Can you explain the differential diagnosis process for pediatric leukocoria at Pediatric Eye Specialists?

Differential diagnosis is a methodical approach used by physicians to identify a disease or condition in a patient. It involves comparing and contrasting various conditions that have similar symptoms to determine the exact cause of the patient’s signs. At Pediatric Eye Specialists, when addressing pediatric leukocoria, we start with a detailed medical history and a full ocular examination. This process helps us to rule out or consider potential causes of leukocoria, including various eye-related disorders such as retinoblastoma, which is a type of eye cancer, or congenital cataracts, which are often present at birth. To aid in distinguishing between these conditions, we may utilize advanced medical imaging techniques, like an ultrasound, which allows us to view the vitreous body—a clear gel that fills the space between the lens and the retina of the eye. Each of these steps is critical in arriving at the correct diagnosis and determining the most effective treatment plan for our young patients.

Can leukocoria be a sign of an underlying systemic condition like cytomegalovirus infection or ocular toxocariasis?

Yes, leukocoria can sometimes indicate systemic infections such as cytomegalovirus or parasitic diseases like ocular toxocariasis. These conditions can lead to visual impairment if not addressed promptly. Our team collaborates closely with pediatricians to ensure comprehensive care for our patients.

How does Pediatric Eye Specialists address congenital eye defects like coloboma that may present with leukocoria?

Congenital eye defects, such as colobomas of the iris or lens, are carefully evaluated by our pediatric ophthalmologists. We employ various diagnostic tools, including specialized medical imaging, to assess the extent of the defect and its impact on vision. Depending on the findings, we create a customized treatment plan which may include monitoring, surgery, or other interventions.

How does Pediatric Eye Specialists manage the risk of vision loss in conditions associated with leukocoria, such as tuberous sclerosis and TORCH syndrome?

When leukocoria is related to complex conditions like tuberous sclerosis (a genetic disorder that causes benign tumors to grow in the brain and other organs) or TORCH syndrome (a group of infections in pregnant women that can cause birth defects), our approach includes close monitoring of the retinal vessels and the eye’s internal structures through medical imaging. We also collaborate with specialists to manage systemic symptoms and prevent vision loss with appropriate interventions.

What support does the American Association for Pediatric Ophthalmology offer for children with leukocoria?

The American Association for Pediatric Ophthalmology is a valuable resource for both ophthalmologists and families. They offer educational materials and support systems that we utilize to ensure our young patients and their families are informed and supported throughout their diagnosis and treatment. All the doctors at Pediatric Eye Specialists are members of AAPOS.

What types of neoplasms are associated with pediatric leukocoria?

In pediatric patients, leukocoria can be associated with neoplasms such as retinoblastoma, which is the most common malignant intraocular cancer in children. These tumors can originate from the retinal tissue and may cause a white reflex, or leukocoria. Our specialists at Pediatric Eye Specialists are experienced in diagnosing and treating such conditions with the utmost precision and care.

How does toxoplasmosis relate to pediatric leukocoria?

Toxoplasmosis, an infection caused by the Toxoplasma gondii parasite, can sometimes lead to ocular complications that present as leukocoria. The infection can cause inflammation and scarring in the retina, which may be seen as a white reflex through the pupil. Early detection and treatment are crucial, and our team is skilled in managing such infectious causes of leukocoria.

What does the presence of an exudate in the eye indicate in cases of pediatric leukocoria?

The presence of an exudate, which is an accumulation of fluid with high protein content and cellular debris, often indicates inflammation or infection within the eye. This can manifest as leukocoria due to the white appearance it gives when viewed through the pupil. At Pediatric Eye Specialists, we conduct thorough examinations to determine the cause of exudate and provide appropriate treatment.

Can changes in eye tissue lead to pediatric leukocoria?

Yes, alterations or damage to the eye tissue, such as from trauma, inflammation, or developmental anomalies, can result in leukocoria. For instance, conditions like persistent fetal vasculature or retinal dysplasia might cause changes in the eye’s internal tissue, leading to a white pupillary reflex. Our pediatric ophthalmologists are adept at identifying these tissue changes and formulating effective treatment strategies.

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