04/03/2017 CommunityEyeHealthJournalHowtotestfortheredreflexinachild

Comm Eye Health Vol. 27 No. 86 2014 pp 36. Published online 21 July 2014.

How to test for the red reflex in a child

Examinationofpupilreflections,also
knownastheredreflextext,canreveal
problemsinthecornea,lensand
sometimesthevitreous,andis
particularlyusefulinyoungchildren.
Thesephotographsshowwhatcanoccur
inthecaseofcertainmajoreye
conditions,themostseriousofwhichis
retinoblastoma.

Itisessentialtotesttheredreflexafter
birth,attheageofsixweeksandalso
duringroutineconsultationsorwhen
Theredreflexiseasiertoseeinadarkenedroom.Heiko
Philippin
parentsareconcernedaboutthechilds
visionortheappearanceofherorhis
eyes.

Thetestcanalertustolargelesionsintheretina.Itcannotbeused,however,toidentify
causesofpoorvisionrelatedtoretinaloropticnervedamage,suchasretinaldystrophyor
opticatrophy.Forthis,appropriatereferralisneeded.

Note:Adimredreflexmayrevealanunequalorhighrefractiveerror.

Procedure
Theredreflexismucheasiertoseeina
darkenedroom,soswitchoffthelights,draw
thecurtainsorasktheparentsandchildto
Figure1.Thenormalredreflex.HeikoPhilippin
accompanyyouintoaroomwhichdoesnot
haveawindow.

Useadirectophthalmoscopewiththe
lenspowersetat0.Makesurethe
batteriesarecharged.

Figure2.Righteye:thenormalredreflex.Lefteye:the
absenceofaredreflexisabnormalandcouldindicatea
seriouscondition.Referthechildtoaspecialist.Childhood
EyeCancerTrust
Sitabouthalfametre(50cm)away.Hold
theophthalmoscopeclosetoyoureyes.
Encouragethechildtolookatthelight
sourceanddirectthelightatthechilds
eyesindividuallyandtogether.You
shouldseeanequalandbrightredreflex
fromeachpupil.

Figure3a.Thewrongcolourinaredreflexisabnormaland
Payattentiontothecolourandbrightness
couldindicateaseriouscondition.Thechildinthisimagehas oftheredreflex.Itshouldbeidenticalin
http://www.cehjournal.org/article/howtotestfortheredreflexinachild/ 1/2
04/03/2017 CommunityEyeHealthJournalHowtotestfortheredreflexinachild
acataractinthelefteye.Referthechildtoaspecialist.Heiko botheyes(Figure1).Anydifference
Philippin
betweentheeyes,anabsenceofthered
reflexoranabnormalcolour(Figures2
4)mayindicateaseriousillness.

NOTE:Theprecisecolourofthered
reflexwilldependonthedegreeof
pigmentationintheeye.Todetermine
Figure3b.Thewrongcolourinaredreflexisabnormaland
couldindicateaseriouscondition.Thechildinthisimagemay
whethertheredreflexisnormal,
haveretinoblastomainthelefteye.Referthechildtoa comparisonwiththeredreflexofaparent
specialist.ChildhoodEyeCancerTrust ofthechildmaybehelpful.Ifyouarenot
surewhetherthereflexisnormal,dilate
thepupilforacompleteexamination.

Adaptedfromtheposter:SeeRED
producedbyJRAinsworth,UKNational
RetinoblastomaService,Birmingham,UK
andtheChildhoodEyeCancerTrust.
Figure4.Theredreflexislessbrightinthelefteyeandthe www.chect.org.uk.
cornealreflectionisnotcentred.Thisisasquint,whichmay
betheresultofaseriousunderlyingcondition.Evenifthereis
nounderlyingcondition,squintmayleadtoamblyopia(loss
FirstpublishedintheCommunityEye
offunctioninthevisualcortex),whichisirreversibleifnot HealthJournalFrenchedition,Issue8,
treatedurgently.Referthechildtoaspecialist.Childhood 2011.
EyeCancerTrust

http://www.cehjournal.org/article/howtotestfortheredreflexinachild/ 2/2