19 month old with white eye in picture

I noticed this in a few of my son's pictures today. The left eye has a white reflex in the photos. I have an ophthalmoscope so I checked for a red reflex and he does have bilateral red reflexes with the ophthalmoscope. I'm not skilled enough to even attempt to look at his fundus with it however.

How worried do I need to be? Will an appointment with his pediatrician be enough or should I make an appointment with a pediatric ophthalmologist directly?

Thanks so much.

[John C Hagan III, MD, FACS, FAAO]

I would go ahead and check with a peds ophthalmologist. the fact that the ophthalmoscope gives a red reflex is a very good sign.

JCHMD

[oxeye]

Thank you so much for your response. I will make an appointment with an ophthalmologist on Monday.

I thought of one other thing. Of course retinoblastoma is in the back of my mind, and I'm hoping that is a very, very small possibility. How long would it take a retinoblastoma to grow large enough to cause the white reflex? I ask because my son had an MRI about 9 months ago for unrelated reasons. Would a retinoblastoma have been visible on a MRI at that time? He had suspected hydrocephalus so I assume the radiologist was not looking closely at his eyes, but the MRI was read as completely normal.

Thanks.

[John C Hagan III, MD, FACS, FAAO]

A RB can be quite developed and present at birth. A large RB would show up on a MRI of the head but smaller ones might not.

If it was a large RB then the ophthalmolscopic image should be white not red.

JCH MD

[oxeye]

I just wanted to update. He was seen by a pediatric ophthalmologist on Monday, he couldn't see the whole retina to rule out retinoblastoma so he did an exam under anesthesia today. He didn't see anything wrong with the left eye thank goodness, and only some mild evidence of retinopathy of prematurity in the right eye which is a little strange given than he was barely premature and did not need any oxygen.

Thanks so much for your help. I'm so glad that it turned out to be nothing.

[John C Hagan III, MD, FACS, FAAO]

I am most happy that it was not a RB.   However ROP is not a benign problem. Be sure to see the pediatric ophthalmologist regularly.

ROP does not require being on oxygen.

JCH MD