The red reflex screening assessment is an important part of a baby’s 6-8 week check, and it’s something we cover in our 6-8 Week Baby Check Review course.

The “red reflex” is the term given to the direct visualisation of the infant’s retina. The primary reason for the red reflex eye examination is to detect congenital cataract, which is an abnormality of the lens. Congenital cataracts may be associated with significant and irreversible impairment of the neonatal visual experience and damage development of the visual pathways of the brain. To preserve vision, early detection and treatment by eight weeks is required.

Other rare ocular abnormalities that may affect the developing visual system may also be found during a red reflex eye examination. A white reflex may be due to an intraocular mass such as a retinoblastoma which requires immediate referral.

How is a red reflex assessment carried out?

Checking for the red reflex is generally completed in a darkened room to allow the pupils to dilate. The baby is held by a parent or caregiver.

Ideally the infants’ eyes are open spontaneously. Often this can be achieved by holding the baby vertically or by gently opening the eyes with clean fingers.

Using a direct hand-held ophthalmoscope with lens focus set between zero and plus 2 (black 2) or for your eye requirements, hold the ophthalmoscope to your eye at a distance of ~40-50cm from the baby’s eye.

The eyes are either examined individually or at the same time by shining the light on the eye(s). Normal red reflexes are symmetrical red or red/orange equivalent in colour, size, intensity and shape comparing the two eyes. In babies with pigmented skin the reflex is more yellow-orange than red.

If the reflex is poor, move the light from side to side and ensure the room is as dark as it can be.

The baby’s eyes should be equal in size. Abnormal findings include black flecks, black areas or shadows, any absence of uniform red appearance or white reflex.

Looking to refresh your 6-8 week baby screening skills?

As mentioned above, red reflex eye examination is covered in PDUK’s online Six-eight-week baby check: update your screening skills course. Offering a flexible, interactive solution for practitioners looking to sharpen their skills, our online courses are proving extremely popular. This makes it really important to sign up as soon as possible!

The course is aimed at clinicians who have already completed a university accredited course and need to meet yearly update requirements. It’s a one-day course worth 8 hours of valuable CPD but as always, spaces are limited so don’t miss out!