In the evaluation of leukocoria, which finding is considered ominous?

In the evaluation of leukocoria, the presence of a white pupillary reflex is considered an ominous finding because it can indicate serious underlying conditions such as retinoblastoma, cataracts, or other intraocular pathologies. The white reflex, or leukocoria, means that instead of the expected red reflex typically seen when light is shone into the eye, a white reflection is observed. This abnormality necessitates further investigation, as it is a potential sign of significant eye disease that could threaten vision or overall health.

A red reflex is indicative of a healthy eye and suggests that the media (cornea, lens, and vitreous) are clear and that the retina is functioning normally. A clear pupillary reflex also implies no obstruction or significant obstruction to the light pathway. A dull pupillary reflex suggests some level of concern, but it does not carry the same alarming implication as leukocoria. Therefore, only the white pupillary reflex serves as a clear and concerning signal for potentially severe conditions in the neonate.