Paeds Cases · ophthalmology
Recognising an absent red reflex and the urgency of congenital cataract — OSCE
Communication and structured-discussion OSCE on a 4-week-old infant with a dense unilateral cataract and absent red reflex, covering the performance of the red-reflex (Brückner) test, the cannot-miss differential of leukocoria including retinoblastoma, deprivation amblyopia and the critical-period surgical window, the Infant Aphakia Treatment Study on aphakia versus primary IOL, the lifelong glaucoma surveillance duty, and the family-centred amblyopia programme of patching and optical correction.
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Candidate instructions (8-minute station)
You are the paediatric registrar in clinic. A 4-week-old term infant is brought by his first-time parents because the child-health nurse thought the left pupil looked white in a photograph. You perform a red-reflex test and find the left reflex absent; the right is a normal orange-red. [11]
Your tasks, each grounded in the evidence below, are: [11]
- Confirm and explain the finding, and explain why an absent or white reflex is urgent — naming the cannot-miss diagnosis and the reason for speed. [12]
- Outline the definitive management and the surgical time-window for a dense unilateral congenital cataract, in language the parents can follow.
- Explain the aphakia-versus-intraocular-lens decision and what the Infant Aphakia Treatment Study showed, so the parents are prepared for the ophthalmology discussion. [7]
- Explain the lifelong glaucoma surveillance the child will need, and why the operation is the start of treatment. [5]
References4ShowHide
- [5]Freedman SF; Lynn MJ; Beck AD; et al Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study. JAMA Ophthalmol, 2015.PMID 25996491
- [7]Repka MX; Sutherland DR; Hatt SR; et al Effects of Age at Surgery and Laterality of Cataract on Visual Acuity 5 Years after Surgery in Infants Left Aphakic. Ophthalmology, 2025.PMID 40582417
- [11]Toli A; Perente A; Labiris G Evaluation of the red reflex: An overview for the pediatrician. World J Methodol, 2021.PMID 34631483
- [12]Anderson J Don't Miss This! Red Flags in the Pediatric Eye Examination: Abnormal Red Reflex. J Binocul Vis Ocul Motil, 2019.PMID 31329054