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Pupil - white spots

Definition

White spots in the pupil is a condition that causes the pupil of the eye to look white instead of black.

Alternative Names

Leukocoria

Considerations

The pupil of the human eye is normally black. In flash photographs the pupil may appear red, an effect called "red eye." This is also called the "red reflex" by health care providers, and is entirely normal.

On occasion, the pupil of the eye may appear white. This is never a normal condition and needs to be seen right away by an eye care provider.

There are many different causes of white pupil. Other conditions also can mimic white pupil. A cloudy cornea (usually, the clear part of the eye) may look similar to a white pupil. The causes of a cloudy or white cornea are different from those of a white pupil, but are also significant and need immediate attention.

Cataracts may also cause the pupil to appear white.

Common Causes

• Coats' disease - exudative retinopathy
• Coloboma
• Congenital cataract (may be hereditary or may result from other conditions, including congenital rubella, galactosemia, retrolental fibroplasia)
• Persistent primary hyperplastic vitreous
• Retinoblastoma
• Toxocara canis (infection caused by a parasite)
• Uveitis

Home Care

If you see a white pupil, make an appointment with your health care provider right away. Pediatricians routinely screen for a white pupil in children. If a child develops a white pupil or cloudy cornea, immediate attention is needed, preferably from an ophthalmologist.

Call your health care provider if

Contact your health care provider if you notice any color changes in the pupil or cornea of the eye.

What to expect at your health care provider's office

The health care provider will perform a physical exam and ask questions, such as:

• When did you first notice this problem?
• Are both eyes affected?
• Is there any change in the vision, including a decrease in vision, blurred vision, or other vision problems?
• What other symptoms do you have?
• Is there a family history of disease such as congenital cataracts or retinoblastoma?
• Are the eyes crossing?
• Have you had any recent eye surgery?

The physical examination will include a detailed eye examination.

The following tests may be performed:

• Ophthalmoscopy
• Slit-lamp exam
• Standard eye exam
• Visual acuity

Other tests may be done, depending on the suspected cause, including a head CT or MRI scan.

References

Fay A. Disease of the visual system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 449.

Guercio JR, Martyn LJ. Congenital malformations of the eye orbit. Otolaryngol Clin North Am. 2007;40:113-140.