Focusing down to the retina and visualizing retinal vessels will verify a normal retina is being seen…A white pupillary reflex is abnormal and may occur with a large retinoblasto ma or developmental abnormalities.19 … Referral of patients with leukocoria to an ophthalmologist is usually indicated.14
Nelson Textbook of Pediatrics, 15th Edition 199615
Ideally, every child should have a thorough ophthalmologic examination sometime in early childhood, preferably by the age of 3–4 years; these are the crucial years for detect ion and treatment of amblyopia, strabismus, high refractive errors, and many other significant disorders. (A table suggests the red reflex test be performed from the newborn period through the 5-year examination).
In the funduscopic examination, use a zero lens and note the presence of a red reflex, or hemorrhages…Any obstruction, such as corneal or lenticular cataract, will obliterate part or all of the red reflex.
Nelson Textbook of Pediatrics, 16th Edition 200017
The presence of bilateral red reflexes suggests the absence of cataracts or of intraocular pathology (chapters 629, 634–639). Leukocoria (white pupillary reflex) suggests cataract, tumor…and warrants an ophthalmologic consultation.