The normal appearance of the pupil of the human eye is black. In flash photographs the pupil may appear red. This is known to photographers as redeye and to physicians as the red reflex -- it is entirely normal.

On occasion, the pupil of the eye may appear white. This is never a normal condition and requires immediate evaluation by trained specialists (ophthalmologists, "eye doctors," not optometrists who can only prescribe lenses or glasses).

There are many different causes for white pupil, which are described below. Other conditions can also mimic white pupil. For example a cloudy cornea (usually, the clear part of the eye) may produce an appearance 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 require immediate attention. Cataracts may also cause the pupil to appear white.

• retinoblastoma
• congenital cataract (may be hereditary or secondary to conditions, such as congenital rubella or galactosemia, retrolental fibroplasia, and other diseases)
• intraocular infections (infections within the eyes)
• persistent primary hyperplastic vitreous
• retrolental fibroplasia (retinopathy of prematurity)
• Coats' disease (exudative retinopathy)

If a white pupil is noted, an immediate appointment with your health care provider should be made. Pediatricians routinely screen for the appearance of a white pupil in children. If a child develops a white pupil or cloudy cornea, immediate attention is required, preferably from an ophthalmologist.

• you note any discoloration of the pupil or cornea of the eye.

The medical history will be obtained and a physical examination performed.

Medical history questions documenting white spots in the pupil may include:

• When did you first notice this?
• Are both eyes affected?
• Is there any change in the vision, including a decrease in vision, blurred vision, or others?
• What other symptoms are also present?
• Is there a family history of disease, such as congenital cataracts or retinoblastoma, both of which tend to be hereditary?
• Are the eyes crossing?
• Any recent eye surgery?

The physical examination will include a detailed eye examination.

Diagnostic tests may include:

• slit-lamp exam
• standard eye exam
• visual acuity
• ophthalmoscopy
• other tests depending on the suspected cause, including a head CT or MRI

AFTER SEEING YOUR HEALTH CARE PROVIDER
If a diagnosis was made by your health care provider as the cause of white spots in the pupils, you may want to note that diagnosis in your personal medical record.