Physical Exam

Eye Red Reflex

also known as Brückner test

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Video coming September 2026

How to Perform

Darken the room and set the ophthalmoscope to a round white light. From about an arm's length away, look through the ophthalmoscope and shine the light onto both pupils or one pupil followed by the other. A normal red reflex is a uniform, bright reddish-orange glow filling the pupil; dark spots, a blunted or absent reflex, or asymmetry between the two eyes are abnormal.

How to Interpret

Anisometropia

Asymmetric Brückner reflex

Rule in

Very helpful

Rule out

Somewhat helpful

Evidence:Limited

Serious Eye Disease

Absent, diminished, or white red reflex in a newborn

Rule in

Very helpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Strong

Strabismus

Asymmetric Brückner reflex

Rule in

Very helpful

Rule out

Minimally helpful

Evidence:Limited

References

Taksande A, Jameel PZ, Taksande B, Meshram R. Red reflex test screening for neonates: a systematic review and meta analysis. Indian J Ophthalmol. 2021;69(8). doi:10.4103/ijo.IJO_3632_20. PMID 34304165.
Amitava AK, Kewlani D, Khan Z, Razzak A. Assessment of a modification of Bruckner's test as a screening modality for anisometropia and strabismus. Oman J Ophthalmol. 2010;3(3):131-135. PMID 21120049. PMC2992160.
Subhi Y, Schmidt DC, Al-Bakri M, Bach-Holm D, Kessel L. Diagnostic Test Accuracy of the Red Reflex Test for Ocular Pathology in Infants: A Meta-analysis. JAMA Ophthalmol. 2021;139(1):33-40. PMID: 33180103. PMC7662495 (free full text).
American Academy of Pediatrics Section on Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology; American Association of Certified Orthoptists. Red reflex examination in neonates, infants, and children. Pediatrics. 2008;122(6):1401-1404.
Brückner R. Exakte Strabismusdiagnostik bei ½–3 jährigen Kindern mit einem einfachen Verfahren, dem "Durchleuchtungstest". Ophthalmologica. 1962;144:184-198.

Research last updated September 9, 2026.