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An Approach to Visual Loss in a Child
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Muhammad Hassaan Ali, Stacy L. Pineles
Congenital cataract affects about 3–5/1000 infants (41). Genetics, antenatal maternal infections and metabolic disorders are considered to be the most common causes of congenital cataracts (42). Early recognition of this pathology is essential to prevent development of dense amblyopia. Pediatricians should be trained to evaluate red reflex of the newborn. If they find any abnormality in red reflex or leukocoria, they should refer the baby for evaluation by a pediatric ophthalmologist. The mother and the affected baby with congenital cataract should be screened for toxoplasmosis, rubella, cytomegalovirus and herpetic infections (TORCH infections). Similarly, pediatricians should evaluate the baby for all metabolic disorders. Rubella is still considered to be a major etiological agent in developing countries. So, the child should undergo detailed systemic evaluation to rule out any other features of congenital rubella syndrome including heart, ear and skin abnormalities.
Ophthalmoscopy
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Ask your patient to fix their vision on a point in the distance. With the ophthalmoscope set to zero, look through it at the patient’s eye, from about 1 metre away. You should observe for a red reflex, which is created by light reflecting off the retina. This is normal. Any abnormalities of the lens, such as cataracts, will appear black.
Newborn and infant physical examination (NIPE)
Published in Alison Edwards, Postnatal and Neonatal Midwifery Skills, 2020
Hold the eyepiece of the ophthalmoscope up to the baby's eye, at arm's length from their face. Direct the circle of light from the ophthalmoscope towards the baby's eye while gently parting the baby's eyelids if necessary. The red reflex is viewed through the ophthalmoscope eyepiece. The colour, brightness and presence of any shadows on the red reflex should be noted in each eye. A white reflex is abnormal.
The utility of a direct ophthalmoscope in estimating the magnitude of refractive error using a modification of the Brückner test
Published in Expert Review of Ophthalmology, 2021
Praveena S. Kumar, Yogish Subraya Kamath
The Brückner test describes the altered red reflex in between the eyes, when viewed from a distance, through the direct ophthalmoscope, in patients with strabismus and anisometropia [5,6]. A careful observation of this red reflex reveals a bright crescent, which occurs as a result of the entry of the reflected rays from the pupil. The position of this crescent is dependent on the refractive error of the eye, as well as the position of the light source. Through a direct ophthalmoscope this crescent is positioned inferiorly in myopic and superiorly in hyperopic eyes [7]. The positions are inverted in case an indirect ophthalmoscope is used [8]. On the basis of this principle, our study sought to detect the type and magnitude of refractive error using a ‘modified’ Brückner test, wherein the glow and crescent position in each pupil were individually observed using a direct ophthalmoscope, and analyzed. Although it would eventually help detection of refractive errors in preverbal children, for initial validation of the process, our study included older children and young adults, as they would be more cooperative for examination. We compared the results of the modified Brückner test with the retinoscopy and subjective refraction of the participants.
Time to diagnosis of retinoblastoma in Latin America: A systematic review
Published in Pediatric Hematology and Oncology, 2019
Clarissa Campolina De Sá Mattosinho, Anna Tereza M.S. Moura, Gabriela Oigman, Sima E. Ferman, Nathália Grigorovski
The Red Reflex Test is a screening tool providing an excellent opportunity for early detection and has been recommended by institutions of relevance in the area60,61. However, disagreements observed by this review are also reflected in the literature, since organizations and medical associations’ recommendations show discrepancies and lack of an international consensus on this matter. A more specific guideline would enable assimilation of Red Reflex Test in the daily practice of pediatricians and general professionals in the early years of child care raising the possibility of earlier diagnosis of retinoblastoma and other diseases presenting with leukocoria such as Coats disease, primary vitreous persistency, congenital cataract, toxocariasis, coloboma among others.62 Another feature that may enhance the results of retinoblastoma screening, is its occurrence in a narrow age group with a specific target population. Also, children in this age group (between 0 and 5 years) are usually the ones who visit pediatricians and health centers regularly and therefore have many opportunities to be screened and diagnosed.63
Detection of anomalies in the red reflex test requires adequate training
Published in Clinical and Experimental Optometry, 2021
Lindsey Rose, John Siderov, Hanita Bhopal, Sheila Mok
A normal result of the red reflex test would be reflexes that appear symmetrical in colour. Variations in the type of red colouration may occur as a result of differences in pigmentation of the fundus of newborn children. Such differences are perfectly acceptable as long as there is symmetry between the two eyes. However, an abnormal result would occur when the colouration between the red reflexes of the two eyes is asymmetric, when there is the appearance of dark areas or shadows in one or both reflexes or when the reflex is white (whole or partial leukocoria).1 Unilateral viewing of each eye is also possible if both eyes cannot be simultaneously viewed.