Paediatric eye examination and red-reflex assessment — branching viva

Opening question

Examiner: Take me through how you would perform the red-reflex test on this infant, and what you would expect to see normally. ^[4]

Candidate (model): I would perform it in a dim room, with the direct ophthalmoscope on the largest, brightest spot at zero or low magnification, standing about an arm's length away, roughly 30 to 45 centimetres, and I would examine both pupils together so I can compare the two reflexes side by side — that simultaneous comparison is the Bruckner test. I would repeat it at a couple of distances and gaze positions and document the result for each eye. Normally I expect a symmetric orange-red or reddish glow of equal brightness, colour and size in both pupils. The glow is light that has passed through the clear cornea, aqueous, lens and vitreous, reflected off the retina and the blood-rich, melanin-rich choroid, and returned out. ^{[4] [1]}