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

British Journal of General Practice, April 2015 209 The red reflex 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 lifethreatening pathology (retinoblastoma). Referrals from general practice are semiurgent 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 in an ill baby with a rash. Yet an ophthalmoscope is quicker and easier to use than a thermometer in a small child. Below is a straightforward pathway for making a reliable assessment in all cases: the assumption is that the room can be darkened to at least a semi-dark state.