II. Indications
- Screening in all children under age 3 years
III. Technique
-
Pupil visualized with direct ophthalmoscope (lens power set to 0) at 2 distances
- Each eye at 12 to 18 inches (30-45 cm)
- Both eyes together at 2-3 feet (60-90 cm)
- Perform in darkened room
-
Pupil Dilation if reflex poor (e.g. pigmented fundus)
- Tropicamide (Mydriacyl) 1% one drop per eye or
- Phenylephrine (Neo-Synephrine) 2.5% one drop/eye
IV. Findings: Normal
- Light reflex normally appears red (Red Reflex)
- Normal if red-orange or even orange-yellow
V. Findings: Abnormal - Leukokoria (White Pupil reflex)
- Precautions
- Leukokoria requires urgent ophthalmology referral
-
Retinoblastoma (most important and urgent)
- Most common childhood intraocular tumor
- Corneal Opacity
- Hyphema or other anterior chamber fluid
-
Coloboma
- Full-thickness eye defect
-
Congenital Cataract
- Opacified or clouded lens (often related to underlying systemic or genetic disorder)
- Often results in absence of Red Reflex (as opposed to white reflex)
- Vitreous opacity
- Primary persistent hyperplastic vitreous (persistent fetal vasculature)
- Hyaline vascular system and Embryonic vitreous fail to involute completely
- Vitreous Hemorrhage
- Due to Trauma or Coagulopathy
- Primary persistent hyperplastic vitreous (persistent fetal vasculature)
-
Retinal Disease
- Retinal Detachment
- Retinopathy of Prematurity
- Toxocariasis
- Chorioretinitis
- Inflammation of the Retina and Choroid (e.g. Cytomegalovirus, Toxoplasmosis)
- Coat's Disease
- Congenitally abnormal sub-Retinal vessels with progressive Vision Loss
- Associated with subretinal fluid and lipid collection
VI. References
- Berson (1987) Ophthalmology Study Guide, AAO, p. 106
- Bell (2013) Am Fam Physician 88(4): 241-8 [PubMed]
- Cheng (1990) Pediatric Ann 19(6): 376-86 [PubMed]
- Essman (1992) Am Fam Physician 46(4):1243-52 [PubMed]
- Mills (1999) Am Fam Physician 60(3):907-16 [PubMed]
- Shields (1991) Retina 11:232-43 [PubMed]
- Simon (2001) Am Fam Physician 64(4):623-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Finding (T033) |
| SnomedCT | 301958008, 43408002 |
| English | red reflex, Finding of red reflex (finding), Fundus reflex, Red reflex, Observation of red reflex, Red reflex present, RR - Red reflex present, RR - Red reflex, Finding of red reflex, Red reflex (finding) |
| Spanish | hallazgo relativo al reflejo rojo (hallazgo), hallazgo relativo al reflejo rojo, cono de luz, reflejo del fondo de luz, reflejo luminoso, reflejo rojo (hallazgo), reflejo rojo |
Ontology: Bruckner test (C1302982)
| Concepts | Diagnostic Procedure (T060) |
| SnomedCT | 400922006 |
| English | Bruckner test (procedure), Bruckner test |
| Spanish | prueba de Bruckner (procedimiento), prueba de Bruckner |
