Exam

Corneal Light Reflex

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Corneal Light Reflex, Hirschberg Test

  • See Also
  1. Pediatric Eye Exam
  2. Ocular Fixation
  1. Differentiate true deviation from pseudostrabismus (due to wide Nasal Bridge or epicanthal folds)
  2. In uncooperative child, only test of alignment
  • Technique
  1. Hold penlight at arms length in front of child
  2. Gain child's attention blink/tap light
  3. When child fixated on light
    1. Examiner lines up light with her eyes
    2. Note position of Corneal Light Reflex on each eye
  • Interpretation
  1. Based on Corneal Light Reflex position
  2. Normal (No Strabismus)
    1. Reflex falls on nasal portion of each Cornea
  3. Esodeviation
    1. On Deviated eye, reflex displaced lateral or temporal
  4. Exodeviation
    1. On deviated eye, reflex displaced medially
  5. Pseudostrabismus (due to wide Nasal Bridge or epicanthal folds)
    1. One pupil will appear more medial (turned in) than the other
    2. However, each light reflection will be centered over each pupil or in the same position as the contralateral side
  • References
  1. Berson (1987) Ophthalmology Study Guide, AAO, p. 95-110
  2. Essman (1992) Am Fam Physician 46(4):1243-52 [PubMed]
  3. Mills (1999) Am Fam Physician 60(3):907-16 [PubMed]
  4. Reedy-Cooper (2023) Am Fam Physician 108(1): 40-50 [PubMed]
  5. Sondhi (1988) J Pediatr Ophthalmol Strabismus 25:210-1 [PubMed]