Red eye reflex is strange

Hello,
I have recognized on my 16 month old daughter's photos, that her righ eye red reflex (with the flash camera) is different from the left eye. Left pupil is all red, the right pupil has an orangish area on the top of the pupil. I see it on older photos too, I can see it more when the photo was taken from a distance and less when it was shot closer. I have seen it on several photos, mostly when she is looking directly into the camera,  when she is looking at something else, it is red too.
I was really worried and took her for an eye exam. I was told, everything is ok, no lazy eye, and good red reflex in both eyes.
Have you ever seen photos like this? What can it be? I have attached.
Thank you for your reply in advance,
Amy

[Ray T Oyakawa, MD]

There might be a slight phoria (the two eyes do not align perfectly--common), the refraction could be different, and course what you are worrying about is some abnormality.  Make sure you are seeing a pediatric ophthalmologist.


Dr. O.

[Ammy76]

I meant to write sometimes it is red sometimes not when she is looking away. (on this pic it shows the difference)

[Ray T Oyakawa, MD]

There might be a slight phoria (the two eyes do not align perfectly--common), the refraction could be different, and course what you are worrying about is some abnormality.  Make sure you are seeing a pediatric ophthalmologist.


Dr. O.

[Ammy76]

Thank you for your answer Ray T Oyakawa MD,

We did see a pediatric ophthalmologist a week ago, he examined my daughter with an opthalmoscope and by the covering eye test. He was sure she does not have reflection problem nor any serious condition. (I was worried about cataract and retinoblastoma)

As she cannot speak yet, she cannot tell if she has vision problem, but by a covering eye test at home too, I do not see problem. She did not remove the test patch, just carried on playing normal.
These kind of photos just make me scared though.

Phoria  - I will check into that.  

Is that different than cross eye?  I did notice her right eye is slightley toward the nose sometimes, but light reflects on the retina on the same place, and the covering eye test showed no fixing movement of the eye, so I was told she has no lazy eye.  

Can phoria be present without having reflective error?

Thank you for your help,
Amy

[Ammy76]

This is a feedback about the problem we had - in case anyone researching this site for similar problem.

We got a second opinion that showed she has myopic astigmatism in both eyes, but more myopic on the eye that shows the orangish lighter crescent in pupil on the flash photos. It is caused by  the shape of the eye, cornea. Her eye is more football shape than ball shape. Actually the amount is -1.5D-2  180.  Did not need correction yet, as my child is too young, and sees good close, what she needs to see now. This astigmatism still can change, get better or even worse later. We need to have control check ups from time to time.

As far as the light crescent concerned, I have found out it shows the refracting error. Its location and size tells the type and size of the refracting error to the trained reader. Its size changes depending on several factors. (gaze, child's distance from camera, and even the distance of the flash and the optics of the camera). For more info you can search "photoscreening".
I have found out, that several children have odd red reflex photos from time to time, but if you see it on several photos of your child,  the child needs a confirmatory eye exam, by a pediatric opthalmologist.