White Eye Warning

In a flash photograph most pupils come back red. Occasionally one comes back white, and that is a reason to have the eye looked at.¹

The white is light returning off something at the back of the eye, and it can be the first sign of a cancer that gives no other warning.¹

Clinicians call it leukocoria. The NHS describes the main sign of retinoblastoma as a white glow or reflection in the centre of the pupil, which may be visible on looking at the eye directly, in low light, or in photographs taken with a flash.¹ A squint, a change in iris colour, swelling, uncontrolled eye movements, vision problems and eye pain are also listed, and the child may otherwise seem entirely well.¹

The sign is not specific to cancer, and it matters that this is said plainly. Leukocoria is the commonest presenting sign of retinoblastoma, but a number of other conditions produce the same appearance.² In a series of 500 children referred for possible retinoblastoma, 212 turned out to have something else: most often persistent hyperplastic primary vitreous, at 28 per cent of those cases, with Coats disease and ocular toxocariasis next at 16 per cent each.² A white reflection is a reason to be examined, not a diagnosis.

The photographic route to finding it has been studied directly. After his son Noah lost an eye to retinoblastoma, Bryan Shaw worked with Greg Hamerly at Baylor University on software that scans a phone's photo library for the sign; it is distributed as the White Eye Detector. Across more than 50,000 photographs taken before diagnosis, it identified leukocoria in 80 per cent of the children who had a diagnosed eye disorder, at an average of 1.3 years before the clinical diagnosis was made, with sensitivity above 80 per cent in children aged two and under.³ The authors present it as a prototype to sit alongside clinical screening rather than replace it.³

The practical step is small. If a white reflection keeps appearing in the same eye, the NHS route is an urgent GP or optician appointment, with referral to an eye specialist inside two weeks.¹