White (Instead of Red) Reflexes on Family Smartphone Photographs Can Be Worrisome, but Also Normal.

Smartphone photos can capture more than childhood memories, as two families learned when noticing unusual reflections coming from their children’s eyes in photographs. In the March 2025 Pediatrics, researchers present a case study of a 13-month-old girl and a 3-year-old boy who were referred to pediatric ophthalmology for a condition known as leukocoria that was first noticed on a smartphone photograph. The case report, “Smartphone-Detected Physiologic Photoleukocoria with Visible Optic Nerve Details” (published online March 13) notes that, rather than reflecting red, leukocoria shows up as a white or gray reflection in eyes and can indicate a serious or dangerous eye condition. Typically, leukocoria is discovered by physicians using the red reflex test with a direct ophthalmoscope. However, it can also be identified with flash photography in a phenomenon termed “photoleukocoria.” The presence of leukocoria can be a sign of cataracts, congenital malformations, retinal detachments, vascular and inflammatory diseases or retinoblastoma, a form of eye cancer. However, they can also be normal, as in these children. When these photographs are zoomed in, clear details of the normal optic nerve can be visualized, according to researchers. They predict that as smartphone usage increases, pediatricians may see more cases of photoleukocoria noted in home photography—urgent referral should be made to pediatric ophthalmology for a full dilated examination to rule out the worrisome causes of leukocoria.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.