Vision Screening Online Training Program - Retinal Reflex (Red Reflex)

Vision Screening Online Training Program

Module 5: Retinal Reflex (Red Reflex)
(C&TC: Often performed by the health care provider)

The two procedures that are a part of this module use light sources to check the child’s pupillary health. The retinal reflex uses an ophthalmoscope and the pupillary light response uses a penlight. These two procedures have separate purposes however. The retinal reflex is primarily checking for disease whereas the pupillary light reflex is screening for muscle or physiological abnormalities. It is wise to carry out these procedures together so that the child will be exposed to direct light in two consecutive tests rather than spaced out through the screening process. Since a child’s eyes are slightly affected by light shined directly in their eyes, their eyes will need a few seconds to adjust after these tests.


The retinal reflex test is normally done by a child’s health provider because an ophthalmoscope is needed. This is the best screening test possible when looking for a leukocoria or retinoblastoma. From the reflex given by the eye, obstructions inside the eye may be detected. It is extremely important that the lights in the room are dimmed so that deviations in the eye may be seen clearly.

Ages: Birth to age 3 years or when visual acuity can be measured.
Purpose: To check for abnormalities that block light flow within the eye by observing the reflected light from the retina. An extremely important irregularity to examine for is leukocoria which customarily gives the appearance of a white pupil caused by the presence of a white mass within the eye.
Description: Observing symmetrical and equal intensity reflexes from the retinae.
Equipment: Ophthalmoscope.
Facilities: Normal to lower light level - minimum number of light sources (windows, overhead lights, etc.).

Position the child so the circle of light from the ophthalmoscope falls just to the outside of both eyes. Looking through the ophthalmoscope you should observe a glow in both pupils simultaneously.

Vision screener using an ophthalmoscope to observe a glow in both pupils of child.

Close-up of a vision screener using an ophthalmoscope to observe a glow in both pupils of a child.


Pass: Reflexes are equal in symmetry of pattern, color and intensity. It is important to note that symmetry of color is important. The color range of yellow - orange - red is normal.

A reflex that is altered in symmetry. In the presence of a leukocoria, one or both pupils may appear white instead of the symmetrical normal red, yellow or orange color expected.

Note: If a leukocoria is detected, an immediate referral is required.

Ophthalmoscope Directions

Joey Bergsma: A child with retinal blastoma.Joey Bergsma, a child with retinal blastoma.

Photo courtesy of Pam Bergsma.

Joey Bergsma, a child with retinoblastoma.

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