A white spot in my child's eye: where it is decides what it is
Where the spot sits decides what it is likely to be and how fast it needs to be seen. A white pupil is the one to act on quickly. The others are sorted here by position.
- Work out where the spot is first: in the pupil, on the clear front of the eye (the cornea), at the edge of the coloured part, or on the white of the eye or the lid.
- A white pupil (leukocoria) needs an eye doctor promptly. AAPOS says many causes are serious, some can affect sight and some can be life-threatening, and it says to see an eye doctor right away.
- A cloudy patch on the cornea seen at birth needs prompt attention, because it can lead to a lazy eye from a blocked view.
- A whitish or yellowish dome at the edge of the coloured part may be a corneal dermoid. It is usually watched or treated according to size, and it can cause astigmatism.
- Keep a clear photo, do not put anything in the eye, and book the first available eye examination.
You notice a white spot in your child's eye, and the questions come fast. Is it new? Is it going to hurt? Is it something I should have seen sooner? The first thing to work out is not what it is, but where it is. Its position decides what it is likely to be, and how quickly it needs to be seen.
This article sorts white spots by position. One position matters more than the others, and it is said plainly in the second section: a white pupil needs an eye doctor promptly. None of the positions can be settled by a photo or a description, so this is a guide to what to look for, not a way to diagnose.
Where in the eye is the white spot?
Look at four places. Is it in the pupil, the round black centre? Is it on the clear window at the front of the eye, the cornea? Is it at the edge of the coloured part, the iris, where the cornea meets the white of the eye? Or is it on the white of the eye or the eyelid?
Each place points to a different group of causes. A spot in the pupil, or a whole pupil that looks white, is the one that needs a doctor promptly. A whitish patch on the cornea, or a small dome at its edge, is a different set of conditions, some present from birth.
If you are not sure where it is, that is itself a reason for an eye doctor to look.
What does it mean if the pupil looks white?
It has a name, leukocoria (from the Greek for "white pupil"), and it means the pupil, which should look black, looks white. The American Association for Pediatric Ophthalmology and Strabismus says it is very important for a child with a white pupil to see an eye doctor right away. It also says plainly why: many of the conditions that cause it are serious, some can affect how well the child sees, and some can be life-threatening.
Take that seriously, and act on it, rather than fear it.
The list of causes is long. AAPOS names cataract (a cloudy lens), retinal detachment, retinopathy of prematurity, eye infections, blood vessel problems in the retina such as Coats' disease, and eye tumours including retinoblastoma. EyeWiki adds others, such as persistent fetal vasculature and coloboma. That range is exactly why nobody can tell from a photo or a description which one it is. Only an examination, usually with dilating drops and sometimes a scan, can.
AAPOS says parents may notice it in bright light, in a dark room or in flash photographs, as a pupil that looks white or pale. Our article on a white glow in photos covers that in detail. If you have such a photo, keep it and show the doctor. The condition to have in mind, because it is time-sensitive, is retinoblastoma, and our article on eye cancer in children explains it calmly.
What to do is one thing. Book an eye examination for the first available appointment. Do not wait for a routine check, do not wait to see if it goes, and do not treat it at home. Ask for a children's eye specialist if you can, and tell the clinic when you call that you are worried about a white pupil.
What if the white spot is on the clear front of the eye?
Then it is a corneal spot, and there are two broad stories: something present from birth, or something that happened later. Either way the cornea is the main window through which light enters the eye, so a white patch on it can affect vision, and it needs an eye doctor.
From birth: EyeWiki describes Peters anomaly as a condition in which the front of the eye did not develop normally, and says the most common sign is a cloudy patch on the cornea seen at birth. It notes that these babies are often first seen by a paediatrician who finds an abnormal red reflex, the red glow in the eye when a light is shone in. A cloudy cornea can block the view through the centre of the eye, and that can lead to deprivation amblyopia (a lazy eye that develops because the brain is not getting a clear picture). The American Academy of Ophthalmology says that treatment of amblyopia must start promptly, and that in some infants surgery has been considered within the first three months. That is why a baby with a cloudy cornea should be seen without delay.
Later in childhood: a new white or cloudy area on the cornea, especially with pain, redness, light sensitivity, a knock to the eye or a contact lens, is a same-day problem. The NHS lists severe pain, light sensitivity and changes in vision as reasons for urgent care, and the American Academy of Ophthalmology lists corneal infections, ulcers and scratches among the causes of eye pain. For a child who has been hit or poked, see what to do when a child is poked in the eye. The American Academy of Ophthalmology says to see a doctor right away after any eye injury, because you may not be able to tell whether it is serious.
What is a white or yellowish bump at the edge of the coloured part?
It may be a corneal dermoid. EyeWiki describes it as a benign growth present from birth, a patch of normal tissue in an abnormal place, usually a whitish or yellowish, dome-shaped lump where the cornea meets the white of the eye. Most sit at the lower outer edge, and some have tiny hairs.
The reason it matters is not the lump itself. EyeWiki says these growths most commonly reduce vision by changing the shape of the cornea, causing astigmatism (an uneven curve that blurs vision), and that can lead to a lazy eye on that side. True blocking of the centre of vision is less common.
What follows depends on size. EyeWiki describes close observation for small ones, with clinic checks about every six to twelve months, including vision, measurement of the lesion and a refraction after dilating drops. Larger ones, or those that affect vision, may be treated surgically. EyeWiki also mentions an association with a rare syndrome that affects the face and ears, so a doctor may look at more than the eye.
What about white spots on the coloured part, the white of the eye or the eyelid?
Each is a smaller story, and most have their own article. A keyhole shape or notch in the coloured part of the eye may be a coloboma, covered in coloboma, a keyhole in the eye. Changes on the white of the eye linked to nutrition are covered in vitamin A deficiency and children's eyes, and bumps on the lid in molluscum on a child's eyelid.
A child with a cloudy lens (cataract) may have a white or grey look in the pupil too, and our article on cataract in children explains why it is not only an older person's problem.
Whatever the position, do not press on the spot, do not put drops, oils or herbal remedies into the eye. Take a clear photo in ordinary light, and bring any flash photos that show it.
What will the eye doctor do about a white spot?
The doctor will look at the eye, check the red reflex with an ophthalmoscope, and usually use dilating drops to see the back of the eye. AAPOS describes the ophthalmoscope examination, with dilated pupils for a better view. EyeWiki describes the red reflex test as the primary method, and says that a dark spot in the reflex, a markedly diminished one, a white reflex or a difference between the two eyes are all reasons for referral to an eye specialist.
Further tests, such as an ultrasound, may follow, depending on what is found. What the doctor is working out is what the spot is and whether it affects vision.
The one action is the same for every position: have it examined, and have the white pupil examined first.
- The pupil, the black centre of the eye, looks white or pale, in a photo or in real life.
- A white or cloudy patch on the front of the eye was seen at birth or has appeared recently.
- There is a white area with pain, redness, light sensitivity, a knock to the eye or a contact lens.
- The spot is growing, or your child seems to see less with that eye.
- You cannot tell where the spot is. That alone is a reason for an eye doctor to look.
Common questions
What does a white spot in my child's eye mean?
Is a white pupil always an emergency?
My baby has a white spot on the eye since birth. What could it be?
What is a white or yellowish bump at the edge of the iris?
Can a corneal dermoid affect vision?
Should I take a photo of the white spot?
Can I put drops or home remedies on a white spot?
- AAPOS · Leukocoria · aapos.org
- EyeWiki · Leukocoria · eyewiki.org
- EyeWiki · Corneal dermoid · eyewiki.org
- EyeWiki · Peters anomaly · eyewiki.org
- American Academy of Ophthalmology · Iridocorneal anomalies in infants · www.aao.org
- American Academy of Ophthalmology · Children's eye injuries: prevention and care · www.aao.org
- American Academy of Ophthalmology · Pain in the eye · www.aao.org
- NHS · Eye pain · www.nhs.uk