Pseudoleukocoria

A 5-month-old girl was noted to have leukocoria by her parents. This was recorded in an indoor video taken with a smartphone using flash at night (Figure 1; Video S1). This was the first documentation of her presentation of leukocoria as most of the prior images were taken without a flash. The next day, the child was taken to a local ophthalmologist. She was administered a drop of mydriatic solution (tropicamide phenylephrine hydrochloride), and her ocular fundus (eye ground) was evaluated. However, the possibility of disease could not be ruled out with sufficient certainty. The child was therefore referred to a children's hospital for an examination 5 days later. A pediatric ophthalmologist was consulted, and four drops of mydriatic eye drops were applied at 10 min intervals; her fundus examination was normal. Leukocoria refers to the reflection of white light through the pupil, instead of the typical black non-reflection or red reflection, in photographs captured with flash.1 The detection of leukocoria prompts consultation with a physician.2 The primary causes of leukocoria are congenital cataracts (60%), retinoblastoma (18%), retinal detachment (4%), persistent fetal vasculature (4%), and Coats’ disease (4%).3 In contrast, pseudoleukocoria is an atypical white reflection in the pupil that is not caused by a pathology; it is a nonspecific artifact of the image. The mechanism of pseudoleukocoria is the reflex from the normal optic disc. It is speculated to crop up occasionally when the image is taken from 15 degrees outward.4, 5 This report documented a pediatric patient with pseudoleukocoria. Several apps4 and color charts5 have been developed to distinguish retinoblastoma from psudoleukocoria. However, their reliability is limited. All children with new-onset leukocoria require an evaluation by a pediatric ophthalmologist within 1 week to rule out retinoblastoma and other fatal or vision-threatening conditions. Yuri Kawashima worked on image processing, and Akihiko Adachi wrote the manuscript. All authors read and approved the final manuscript. Patient consent has been obtained and can be provided upon request. Permission for the publication of the patient's photograph and video of her face in the journal and web page has also been obtained from the patient's parents. The authors declare no conflict of interest. Due to the retrospective nature of the case report, ethical approval was not required. Access to the data analyzed in this study may be requested from the corresponding author. Video S1 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.