Referral guideline – Abnormal red reflex (or white reflex)

Introduction

Screening of the ‘red reflex’ should occur at every child health check. Any asymmetry of the red reflex is abnormal. Opacities anywhere in the eye, from the cornea to the retina will produce an abnormal reflex. Opacities may be white or yellow, show black focal areas, or there may simply be an overall dim reflex.

It is important to note however that the ‘brightness’ of the red reflex will vary in children of different racial or ethnic backgrounds, depending on the level of pigmentation in the fundus.

A white reflection (leukocoria) could represent a number of conditions including:

  • congenital cataract
  • retinoblastoma
  • corneal scarring.

GP management

In a darkened room, shine the light from an ophthalmoscope briefly through both pupils simultaneously, looking for an orange/red reflection (Bruckner reflex).

Also check the corneal light reflex, pupillary reactions and sizes, ocular motility, fixing and following, and fundus examination if possible.

When to refer

  • Absence of red reflex or white or ‘glowing’ pupil – IMMEDIATE REFERRAL and call the on-call ophthalmology registrar.

Essential referral info

  • Presenting complaint and reason for referral
  • Full ocular examination findings
  • Patient details (name, age and gender)
  • Medicare number
  • Parent/carer’s name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Ocular history, including other eye problems, injuries, diseases, surgery, treatments including glasses and/or amblyopia therapy.
  • Other past medical and surgical history.
  • Antenatal and perinatal history that may be relevant – prematurity, birth weight, birth trauma, alcohol/drug use in pregnancy.
  • Family history – of eye conditions or genetic conditions.
  • Current medications and allergies.
  • Examination findings – including any dysmorphic features, full ocular examination.
  • Is the patient of Aboriginal or Torres Strait Islander descent?

Parent service

Ophthalmology

Contact details

Hospital Switchboard
(Ask for Ophthalmology On-call Registrar)
t: 07 3068 1111

Resources

Description of Red Reflex (Bruckner) test
Red Reflex video
List of CHQ aligned optometrists
Emergency Eye Manual
Paediatric Optometry Alignment Program