Seeing red in young children: the importance of the red reflex.

Abstract

The single most important piece of clinical information that a paediatric ophthalmologist requires is the presence or absence of a red reflex. An absent red reflex usually suggests sight-threatening pathology (cataract) and may mean life-threatening pathology (retinoblastoma). Referrals from general practice are semi-urgent and need assessment within the week. In children <2 years of age, referrals that do not mention the red reflex state make it difficult to assess the degree of urgency. Inevitably, this means that some children may have a worse outcome as a result of delayed diagnosis. The opposite situation arises where a 6-week-old baby with ‘pale’ or ‘absent’ red reflexes (usually because of ethnic variation) is referred and seen within a week, only for the parents to be told that their child has ‘normal’ red reflexes. It is hardly surprising that parents express sentiments including bewilderment, anger, and great relief. To a paediatric ophthalmologist, the importance of a red reflex in a child aged <2 years is similar to the importance of temperature measurement …