Vision Screening Online Training Program

Module 4 (continued): Corneal Light Reflex
(C&TC: Often performed by the health care provider)

The Corneal Light Reflex test is used to check for milder forms of constant strabismus.

Ages: 2 months through 8 years (C&TC) or 3rd grade (Early Childhood and school screenings).
Description: By noting the position of light being reflected in the pupils, the observer is able to check for a less obvious constant strabismus.
Equipment: A penlight is required for this test as well as a small target object that should be used to keep the child’s vision fixed in a forward gaze. Small toys of cartoon characters are especially useful for this activity. It is very important that a proper light source is used.
Procedure:

Position the child so that the penlight, target object, and the examiner's line of vision are at the same level as the child's eyes. The distance between the target object, penlight and the child’s eyes should be about 14-16 inches. Use the object/toy to attract the child’s attention. If they are old enough, tell them to concentrate their sight on one specific part of target object. With the penlight directly above or resting on the target object, shine the penlight at the center of the child's forehead directly above the child's eyes. Look to make sure the child is still focused on the target. The screener then observes the reflected light in each pupil.

See example below on how to hold the penlight, with the light resting on the toy at a distance of 15 inches.

Example:

With the child’s gaze fixed on the target object (toy), the penlight should be resting on the target object and shining directly above the child’s eyes. The distance between the light and the child’s face should be about 14-16 inches.

Image of a screener using pen light during examination within a distance of 14-16 inches.

Note: The white spots in each pupil are actually the reflection of the light from the penlight that is being shined in the eyes.

Image of child's eyes with white spots in each pupil that are the reflection of the light from the screener's penlight.

Facilities:

Normal or lower light level. Minimum number of light sources (windows, overhead lights, etc.) Child’s back should be to any light source in the room to avoid extra reflection of light in the eyes. This next example shows how the reflection should appear (if normal) and how other light sources may confuse the interpretation.

Example:

Image of child's eyes with white spots in each pupil that are the reflection of the light from the screener's penlight.

Note: The white spots in each pupil are actually the reflection of the light from the penlight that is being shined in the eyes.

Image of a child's eyes where the main light reflection is in the same position in each eye and extra light reflections in each eye are due to the reflection of the ceiling light.

Note: The main light reflection is in the same position in each eye. Also note the extra light reflections in both eyes that are due to the reflection of the ceiling light.

Pass: The reflection of the light appears to be symmetrical in the pupil of each eye.
Rescreen/
Refer:
The reflections of light appear to be asymmetrical (See Abnormal Eye Examples).
Note:

Sometimes an eye may look crossed and it really is not, this is called pseudo-strabismus. Pseudo-strabismus is most often found in infants due to a wide, flat nose and a fold of skin at the inner eyelid (called epicanthal folds) that makes the eyes appear crossed (See Example of Pseudo-Strabismus). Prominent epicanthal folds, together with an upward, outer slant of the eyelids are common in Asian children, but may be suggestive of Down syndrome in children of other ethnic groups.

Note: If the child wears prescription glasses, it is important that the child wears them during this procedure (See Example of Corneal Light Reflection with Glasses).

Question

If a pen light is not available, it is okay to use overhead ceiling lights to perform this test?

True
False


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