Ophthalmology Book

Anatomy

Corneal Disorders

Eyelid Disorders

Glaucoma

Lacrimal Disorders

Miscellaneous

Pediatrics

Pupil Disorders

Retinal Disorders

Sclera Disorders

Traumatic Injury

Vision Disorders

http://www.fpnotebook.com/

Pupillary Light ReflexAka: Red Reflex, Leukokoria, White Pupil, Bruckner Test, Cat's Eye Reflex

Advertisement

  1. Indications
    1. Screening in all children under age 3 years
  2. Technique
    1. Pupil visualized with direct ophthalmoscope at 1-2 feet
    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
  3. Normal Findings
    1. Light reflex normally appears red (Red Reflex)
    2. Normal if red-orange or even orange-yellow
  4. Abnormal: Leukokoria (White Pupil reflex)
    1. Requires urgent ophthalmology referral
    2. Causes
      1. Retinoblastoma (most important and urgent)
      2. Corneal Opacity
      3. Hyphema or other anterior chamber fluid
      4. Congenital Cataract
      5. Vitreous opacity
        1. Primary persistent hyperplastic vitreous
      6. Retinal disease
        1. Toxocariasis (granulomas involving retina)
        2. Retinal Detachment
        3. Retinopathy of Prematurity
        4. Coat's Disease (subretinal fluid, lipid collection)
  5. References
    1. Berson (1987) Ophthalmology Study Guide, AAO, p. 106
    2. Essman (1992) Am Fam Physician 46(4):1243
    3. Mills (1999) Am Fam Physician 60(3):907
    4. Shields (1991) Retina 11:232
    5. Simon (2001) Am Fam Physician 64(4):623

Navigation Tree