Table 1.

Red reflex test - Recommendations for interpretation and referral[4]

• All neonates, infants, and children should have an examination of the red reflex of the eyes performed by a pediatrician or other primary care clinician trained in this examination technique before discharge from the neonatal nursery and during all subsequent routine health supervision visits.

• The result of the red reflex examination is to be rated as normal when the reflections of the two eyes viewed both individually and simultaneously are equivalent in color, intensity, and clarity and there are no opacities or white spots (leukocoria) within the area of either or both red reflexes.

• All infants or children with an abnormal Brückner reflex or absent red reflex should be referred immediately to anophthalmologist who is skilled in pediatric examinations.

• The referring practitioner must communicate the abnormal findings directly to the ophthalmologist and receive confirmation back from the ophthalmologist that proper follow-up consultation was performed.

• Infants or children in high-risk categories, including relatives of patients with retinoblastoma, infantile or juvenile cataracts, retinal dysplasia, glaucoma, or other vision-threatening ocular disorders that can present in infancy, should not only have red reflex testing performed in the nursery but also be referred to an ophthalmologist who is experienced in examining children for a complete eye examination regardless of the findings of the red reflex testing by the pediatrician.

• Infants or children in whom parents or other observers describe a history suspicious for the presence of leukocoria in one or both eyes should be examined by an ophthalmologist who is experienced in the examination of children.

Adapted from: American Academy of Pediatrics, Section on Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, American Association of Certified Orthoptists. Red reflex examination in neonates, infants, and children. Pediatrics. 2008;122:1401-1404