Rapid strabismus screening for the pediatrician

Abstract

"I thought I saw my child's eyes turning" is a frequent observation of parents. The Brueckner test is a simple method, easily learned, to determine the presence or absence of true strabismus. With some practice, an observer can uncover strabismus and amblyopia. This test makes use of a direct ophthalmoscope and the same corneal reflexes one is familiar with in pen light testing. The position of the corneal light reflex is an important portion of the Brueckner test, but the additional, definitive information is derived from the red reflex that fills the entire pupil and gives an excellent backdrop to the bright white dot that is the corneal light reflex. The eye that is turned in or out will have a brighter, more orange-red reflex and the appearance of increased pupil size. Even with pseudostrabismus or unusual angle kappas, the equality or inequality of the red reflex determines the absence or presence of true strabismus. With practice, the Brueckner test can yield the doctor an answer to one of the most common parental concerns.