WHY DOES THE EYE OF A BABY HAVE WHITENESS?

We need a transparent layer inside the eye for vision. Light comes inward from the transparent glass-like layer at the front, which we call the cornea, and then it is directed into the structure we call the anterior chamber. It is filtered through the transparent lens tissue and reaches the vitreous tissue, which is like egg white and also transparent, that fills the eye. These areas are responsible for carrying photons to the retinal tissue, which perceives light.
A photon of light reaching the posterior segment is perceived by the cells in the retina and reaches the brain as data through the optic nerve. Loss of transparency in any of these ways disrupts the reflection of light inside the eye and creates a whitish reflex in the pupillary reflex instead of the traditionally expected reddish image, and this condition is called “leukocoria” in medical terms. It causes vision loss in the baby because it prevents light from reaching the eye. Therefore, diagnosis is very important. To briefly explain these; When there is a white pupil reflex, the first thing that comes to mind is congenital cataract.

The baby’s lens, which should be transparent, has become cloudy as if it were an old person, and the image has become blurry. This condition can sometimes be unilateral, sometimes bilateral.

The family’s history of cataracts in previous babies or in babies of cousins-uncles-aunts is very important because this condition is mostly transmitted genetically.

Another problem that impairs vision is the abnormal vascular structures and connective tissue bands that develop inside the normally transparent structure of the vitreous tissue. This condition is called persistent hyperplastic primary vitreous shortly PHPV. This structure is usually unilateral and can impair eye development in some babies and cause the eye to remain small. Congenital cataract, congenital glaucoma and retinal detachment, which occurs when the retinal layers are separated, may accompany the condition due to the abnormal development of the intraocular structures. We do not often encounter a family history in PHPV patients. One of the most feared conditions, retinoblastoma, is a tumor that develops in the retinal tissue. Tumor cells that develop abnormally in the area of ​​the retina that should see light and transmit it to the brain, both impair vision and threaten life. It can be unilateral and, unfortunately, sometimes bilateral. The presence of retinoblastoma in the family and especially in siblings should definitely be questioned. Genetic counseling is recommended for such families. In the event of this diagnosis, the baby should be seen by both an ophthalmologist and a pediatrician, because retinoblastoma is a life-threatening tumor.

The infection caused by toxocariasis, a parasite transmitted from dogs, in the retina and vitreous tissue is called toxocariasis. Infection in the retina can cause the death of rod and cone cells, while infection in the vitreous can cause both loss of transparency and the formation of band structures, pulling and separating the structures inside the eye, which is what we call detachment. Late diagnosis can cause problems leading to permanent blindness. Diagnosis can be made with eye examination and special laboratory tests.

The biggest problem of premature and low birth weight babies, premature retinopathy (ROP), moves from the retinal tissue into the vitreous, detaches the retina from its place and forms bands in the vitreous. This condition can cause permanent vision loss. The detached retina reveals itself by giving a white image in the eye and causes leukocoria. The risk is especially higher for premature babies under 32 weeks and babies with a birth weight under 1500 grams.

Although rare, Coats disease is a disease that should be kept in mind. It is a retinal vascular disease. Yellowish fluid leaking from the vessels in small foci accumulates between or under the retinal tissues and causes separation in the retinal tissue.
We know that this disease, which is mostly seen unilaterally, is more common in boys.
There are also rarer diseases seen in addition to these, but we have briefly explained the ones we encounter more frequently in practice. It is very important for an eye doctor to see a healthy red reflex in a baby due to the diseases we have listed above, so we can say that babies’ eye checks start from the moment they are born. I wish everyone healthy days.