Paediatric
Leukocoria
Also known as: leukocoria, white reflex, white pupil child, abnormal red reflex child, retinoblastoma white reflex
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A white or asymmetric pupil reflex in a child, usually noticed by a parent in photographs or in particular lighting. Reduced vision, an eye turn or poor fixation may accompany it, though some children are otherwise well. The finding matters whatever else looks normal, because retinoblastoma is among its causes, and a white reflex seen only intermittently in photographs still warrants immediate paediatric ophthalmology referral.
Recognition
Symptoms: what patients report
- Parent notices a white pupil or white reflex in photos or certain lighting.
- Associated reduced vision, squint, or poor fixation may be reported.
- Some children are otherwise asymptomatic.
Signs: what the examination shows
- White reflex or asymmetric red reflex on direct ophthalmoscopy or photography.
- Associated strabismus, reduced fixation, or reduced vision may be present.
- The finding may be intermittent in photographs but is still clinically important.
What OptoGuide™ covers for leukocoria
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Leukocoria — AAPOS
- Leukocoria — EyeWiki
- A Child With a White Pupil. Lahrouchi N, Bosscha MI, Moll AC. JAMA. 2014;311(17):1799-800.
- Retinoblastoma and beyond: pediatric orbital mass lesions. Rumboldt Z, Dodig D, Galluzzi P, et al. Neuroradiology. 2025;67(2):469-492.
- Differential Diagnosis of Leukokoria: Radiologic-Pathologic Correlation. Smirniotopoulos JG, Bargallo N, Mafee MF. Radiographics : A Review Publication of the Radiological Society of North America, Inc. 1994;14(5):1059-7
- Paediatric Ophthalmology State-wide Referral Criteria for Public Outpatient Services (v1.0, May 2024). NSW Health.
- RANZCO Paediatric Referral Guidelines (April 2025). Royal Australian and New Zealand College of Ophthalmologists.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.