Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 20, 2021; 11(5): 263-277
Published online Sep 20, 2021. doi: 10.5662/wjm.v11.i5.263
Evaluation of the red reflex: An overview for the pediatrician
Aspasia Toli, Asli Perente, Georgios Labiris
Aspasia Toli, Asli Perente, Georgios Labiris, Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
Author contributions: Toli A designed the research, performed the literature research and wrote the article; Perente A performed the literature research and wrote the article; Labiris G supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Georgios Labiris, MD, PhD, Associate Professor, Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana Alexandroupolis 68100, Greece.
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: May 6, 2021
Revised: May 19, 2021
Accepted: August 3, 2021
Article in press: August 3, 2021
Published online: September 20, 2021

Red reflex test (RRT) is a simple, non-invasive method that can be performed easily by pediatricians during the clinical examination in neonatal period, infancy and childhood. Abnormal reflexes can lead to prompt diagnosis of several ocular disorders, with potentially severe consequences on patient’s vision, cognitive function and even life.


To underline the contribution of pediatricians to early detection of vision and life threatening diseases by using RRT effectively.


For the present systematic review, PubMed searches were performed using the key words “red reflex and newborn”; “red reflex and neonate”; “red reflex and complications”; “red reflex and necessity”; “red reflex and retinoblastoma”; “red reflex and congenital cataract”; “red reflex and glaucoma”; “red reflex and prematurity”; “red reflex and leukocoria”; “red reflex and blindness”; “red reflex sensitivity and specificity”; “red reflex and differential diagnosis”; “red reflex and guidelines”. The relevant articles were selected without language restrictions. When a full-text publication was not available, their English abstracts were used. In some cases, studies from the reference lists of the selected articles provided useful information. The research took place in September 2020, in the Ophthalmology Department of University Hospital of Alexandroupolis.


A total of 45 articles were selected according to the used key words. After reviewing data from these articles, it is supported that red reflex remains an effective tool of undeniable importance for early detection of severe eye conditions, such as cataract, retinoblastoma, retinopathy of prematurity and glaucoma. Although literature reports some limitations of RRT, including a notable percentage of false positive tests, the inability to detect small, peripheral retinoblastomas and the lower sensitivity for posterior segment pathology, it is widely accepted that the benefits from the regular evaluation of the test on public health are significant. Therefore, RRT has been established by international guidelines and should be an essential component of pediatricians clinical practice. Red reflex implementation should be incorporated in pediatricians educational programs, so that they would be able to provide quality services and safe diagnoses.


The implementation of RRT should be encouraged in all neonatal/pediatric departments. Prompt education of pediatricians should be empowered in order to achieve careful vision screening, according to current guidelines.

Keywords: Red eye reflex, Leukocoria, Visual screening, Newborn, Prevention, Pediatric examination

Core Tip: Red reflex test (RRT) is an easy, non-invasive examination that enables detection of vision- and life-threatening eye disorders. Various studies have dealt with the effectiveness, sensitivity/specificity and abnormalities of the RRT. The aim of the present review is to emphasize the advantages of RRT implementation from neonatal period to childhood and to underline the pediatricians’ role in early diagnosis and treatment of the aforementioned diseases. This study presents a practical guide for the evaluation of the RRT, based on literature data. With appropriate education and compliance to the vision screening protocols, the pediatric society could reduce the incidence of preventable pediatric blindness.