The Red Reflex Test and Leukocoria in Childhood

Joana Santos Oliveira; Sara Catarino; Augusto Magalhães; Gustavo Rocha; Renato Santos Silva

doi:10.20344/amp.21367

Authors

Joana Santos Oliveira Department of Ophthalmology. Unidade Local de Saúde de São João. Porto. Portugal. https://orcid.org/0000-0003-0260-8469
Sara Catarino Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal. https://orcid.org/0000-0002-7774-9357
Augusto Magalhães Department of Ophthalmology & Reference Centre of Inherited Metabolic Diseases at the Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal.
Gustavo Rocha Department of Neonatology. Unidade Local de Saúde de São João. Porto. Portugal. https://orcid.org/0000-0003-3057-6054
Renato Santos Silva Department of Ophthalmology. Unidade Local de Saúde de São João. Porto.; Department of Surgery and Physiology. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. https://orcid.org/0000-0003-0932-8398

DOI:

https://doi.org/10.20344/amp.21367

Keywords:

Child, Pupil Disorders/diagnosis, Reflex, Pupillary, Retinoblastoma/diagnosis

Abstract

The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.

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