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Photography in Paediatric Ophthalmology!


Do you know that a simple picture may help diagnosing eye diseases in children?


You have probably read, heard of or witnessed some story about a picture helping to diagnose, treat and heal a serious eye disease threatening a child’s vision (and eventually life) thanks to the image anomaly on the red brightness of pupil.

Photography has spread in our daily lives and it is now very easy to make high quality images, once mobile cameras are equipped with better and better lenses. Therefore, we are taking more and better pictures, and then sharing some of them in digital groups of friends and social media. Paying attention to a few details may contribute to investigate an eye disease suspicion, which is flagged by camera flash reflex in the retina known as the “red reflex” and simulates the red-eye exam clinical test, which is used in Paediatric Ophthalmology appointments.



Red reflex is produced when a camera flash brightens the retina and choroid (that are highly vascularized) and so they present a red-orange tonality. Therefore, if eyes are aligned with camera and if both eyes reflection are red, it is usually a good indication of clear and healthy optical elements to the retina (cornea, crystalline and vitreous).

An “abnormal red reflex” is a white, yellow or black reflection in one or both eyes. That may be an alert for some eye disease requiring diagnosis by a paediatric ophthalmologist.

Nevertheless, we should make sure the picture is taken in optimal conditions before classifying a red reflex test as abnormal. Therefore:


  1. Children should be looking straight to the camera lens
  2. Camera flash must be on with a is poorly lit background
  3. “Delete red eyes” option must be turned OFF


Despite what has been written, alarm bells not always ring… Many times, a less vivid or dimmed reflection is not necessarily a symbol of abnormality. Children may be simply fixing a point in the right side of the camera: then the whitish reflection occurs in the left eye because the optical nerve is perfectly aligned with both camera and flash… This is why all these 3 assumptions are so important.

On the other hand, the most common cause for abnormal or asymmetric red reflex is some refractive error, like high myopia, astigmatism or hyperopia. Refractive error means that, due to its format, the eye cannot refract light properly and so we see a blurred image. In such cases the problem is solved with eyeglasses, which helps to avoid or mitigate amblyopia’s development in children.

Often parents are also suspicious about strabismus when noticing visual axes misalignment between both eyes. When it really happens, it may coincide with more unilaterally cloudy red reflex test (of the affected eye). Generally, strabismus treatment includes the use of eyeglasses, optic penalty (eye patches) and surgery. If detected and treated on an early stage, usually strabismus may be corrected with excellent results.

Dangerous Sign…

In less frequent occasions, but when diagnosis cannot be delayed, abnormal reflection may indicate more dangerous eye diseases.

A white tumor covering most of the pupil (known as leukocoria) is generally a more worrying situation and a sign to different severe eye diseases, including cataracts, vascular diseases and retinal detachment. In these cases it is always fundamental to exclude the possible presence of a retinoblastoma, a rare but severe eye neoplasm in children. When early detected and treated, retinoblastoma is curable in 95% of all cases.

Yellow tumor may be a sign of Coats’ disease, a disease of retinal blood vessels that becomes ill-formed, tortuous and incompetent, causing exudation, edema and cellular destruction that may cause progressive vision loss and retina detachment. It mainly occurs in boys with less than 10 years old and usually affects only one of the eyes. Treatment may include laser surgery, cryotherapy or, in more advanced disease stages, some more invasive surgery.


When to look for help?

Checking presence, quality and symmetry of red reflex is something routinely made by Paediatric and Family Doctor in programmed appointments for child health (using ophthalmoscope) and it is also registered in Children’s Health Bulletin. It is a clinical procedure made with all newborns before they are discharged from hospital and in the first ambulatory medical appointment. When presenting some abnormal sign, baby is submitted to Paediatric Ophthalmology consultation.

When suffering from aforementioned diseases, its establishment may occur lately during the first years of life, this is, red reflex is normal during birth and only changes at a later stage. That’s why paying attention to pictures can be of great help in early detection and prompt search for a Paediatric Ophthalmology… A picture worthing a thousand words…


If you detect any abnormal reflection or if you are having some doubts, schedule an appointment!

Sources:  American Academy of Ophthalmology – Prevention tips (in English); American Association for Pediatric Ophthalmology and Strabismus – Eye Terms (in English)



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