One of the saddest cases I have ever seen was a little girl who was brought in by her father because one eye looked white in the pupil of one eye. I have seen a white pupil often in adults, usually from an advanced cataract or even a retinal detachment. But in a child, your first thought is cancer of the eye. You may have seen the story recently about the mother that detected a problem in her child by taking a cell phone picture. Either on Facebook or CNN:
or ABC News:
First of all, the pupil is the window into the eye. Some say it’s the window to the soul but definitely it is a window into the overall health of the body. It looks black normally because light doesn’t escape or reflect out easily as in some animals like cats and dogs. If the pupil is big enough or you get enough light to shine in, you can see a reddish-orange reflection with the right tools.
The retina is the inner back lining of the eyeball that detects light and sends the signals through the optic nerve to our brain in order for us to interpret what we see. The eye is the camera, the brain is the TV set basically. I used to say the retina is like film in a camera but with everything digital now, I have changed the analogy to the digital sensors in your phone or digital camera. Anyway, the retina have ALOT of blood supply. Between that and the layer of pigment cells on the outer layer, the color generally appears reddish-orange.
Eye doctors use that reddish-orange reflection to determine the amount of refractive error like nearsightedness or astigmatism a person has for glasses. That is how we can tell what power glasses need to be for little babies or people who can’t talk. It is also how we know if your child is malingering (faking) the need for glasses.
If that reflection is dim, has shadows, or a different color, that tells us there is something wrong with the pathway for light entering the eye. Either the lubricating tear film on the front surface, the cornea, the crystalline lens, the vitreous fluid, or the retina could have a problem.
Retinoblastoma is a fairly rare cancer that usually develops in very young children but it is possible for an adult to develop it too. It is from a genetic mutation of the retinal cells and the risk of passing the gene to offspring can be higher for those families that have had someone affected. It is very aggressive and can spread to other parts of the body very quickly. The sooner the eye is removed that better chance of survival. Yes, the eye needs to be removed quickly. As tragic as that sounds, children adapt fairly well since they are not seeing out of the affected eye anyway.
I encourage young parents to take a picture of their child with a flash straight on from 3-4 ft away. I do it to screen children and to help them relax by showing them their picture so they get comfortable with me examining their eyes before I do more. Both pupils will either be dark if the pupils are too small or both a reddish-orange glow, which is the reflection off the retina. If it is orange, you can enlarge the picture and look for shadows, which could indicate a problem with the surface of the eye or cataracts. Yes, children can have cataracts, though rare. If a reflection is white, it could be a refractive error (nearsightedness, astigmatism, etc.), a cataract, a retinal detachment or retinoblastoma possibly and you would want that checked immediately by having the child’s eyes dilated. They may have to be given a sedative to get them to cooperate and get a good view. If the doctor is not getting a view because the child is not cooperating or crying, the child should be referred to someone who will perform a sedated eye examination, most often a pediatric ophthalmologist.
As a side note, there should also be a little white reflection on the cornea, the front surface of the eye, from the flash. That white dot from the flash should both be in the same relative position to the pupil of each eye. If not, your child could have an eye turn.
Also, all children under 18 are mandated to be covered for at least a wellness eye exam once a year under the Affordable Care Act (Obamacare).
Please have your kids eyes examined at 3-4 years of age at a minimum and every year after that. Just because they seem to get around doesn’t mean that both eyes are okay. If one is not seeing well or turned, the vision won’t develop properly and it is permanent after age 6-7 years old when the optic nerve quits developing. Don’t take any chances with the vision and the health of your child.
Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry. Serving the Dumas, Texas, Moore County and upper Texas Panhandle area for 25 years. Call (806) 935-2020 for appointment or visit our optical gallery without an appointment. Visit our website www.visionsource-dumas.com for more information. Like our Facebook business page: Dumas Vision Source and you can also connect on Twitter @eyedocdumas
Tory Moore, OD – “A Hometown Eye Doctor You Know and Can Trust!”