Purpose: To describe an optical phenomenon producing leukocoria in off axis flash photographs of children who have a normal ophthalmic examination.
Design: Observational case series.
Methods: Description of three otherwise well children who presented to a pediatric ophthalmologist with unilateral leukocoria seen in flash photographs. The children underwent a full ophthalmic examination, including dilated fundus examination.
Results: All ophthalmic examinations were normal. The photographs were all found to be approximately 15 degrees off axis with the leukocoria seen in the eyes where the flash illuminated the nasal retina.
Conclusions: Leukocoria can be seen in normal eyes when the child is not fixing directly on the camera. That is due to reflection off the optic nerve head.