Exam

Red Reflex

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Red Reflex, Leukokoria, White Pupil, Bruckner Test, Cat's Eye Reflex

  • See Also
  1. Pediatric Eye Exam
  • Indications
  1. Screening in all children under age 3 years
  • Technique
  1. Pupil visualized with direct ophthalmoscope (lens power set to 0) at 2 distances
    1. Each eye at 12 to 18 inches (30-45 cm)
    2. Both eyes together at 2-3 feet (60-90 cm)
  2. Perform in darkened room
  3. Pupil Dilation if reflex poor (e.g. pigmented fundus)
    1. Tropicamide (Mydriacyl) 1% one drop per eye or
    2. Phenylephrine (Neo-Synephrine) 2.5% one drop/eye
  • Findings
  • Normal
  1. Light reflex normally appears red (Red Reflex)
  2. Normal if red-orange or even orange-yellow
  • Findings
  • Abnormal - Leukokoria (White Pupil reflex)
  1. Precautions
    1. Leukokoria requires urgent ophthalmology referral
  2. Retinoblastoma (most important and urgent)
    1. Most common childhood intraocular tumor
  3. Corneal Opacity
  4. Hyphema or other anterior chamber fluid
  5. Coloboma
    1. Full-thickness eye defect
  6. Congenital Cataract
    1. Opacified or clouded lens (often related to underlying systemic or genetic disorder)
    2. Often results in absence of Red Reflex (as opposed to white reflex)
  7. Vitreous opacity
    1. Primary persistent hyperplastic vitreous (persistent fetal vasculature)
      1. Hyaline vascular system and Embryonic vitreous fail to involute completely
    2. Vitreous Hemorrhage
      1. Due to Trauma or Coagulopathy
  8. Retinal Disease
    1. Retinal Detachment
    2. Retinopathy of Prematurity
    3. Toxocariasis
      1. Granulomas involving Retina
    4. Chorioretinitis
      1. Inflammation of the Retina and Choroid (e.g. Cytomegalovirus, Toxoplasmosis)
    5. Coat's Disease
      1. Congenitally abnormal sub-Retinal vessels with progressive Vision Loss
      2. Associated with subretinal fluid and lipid collection
  • References
  1. Berson (1987) Ophthalmology Study Guide, AAO, p. 106
  2. Bell (2013) Am Fam Physician 88(4): 241-8 [PubMed]
  3. Cheng (1990) Pediatric Ann 19(6): 376-86 [PubMed]
  4. Essman (1992) Am Fam Physician 46(4):1243-52 [PubMed]
  5. Mills (1999) Am Fam Physician 60(3):907-16 [PubMed]
  6. Shields (1991) Retina 11:232-43 [PubMed]
  7. Simon (2001) Am Fam Physician 64(4):623-8 [PubMed]