Absent Red Reflex – My Newborn’s Experience

Have you ever noticed the reddish tint in your pupils when a photo is captured with the camera flash turned on? 

This seemingly insignificant characteristic can provide important insights into a child’s eye health, particularly in newborns. Crucial vision screenings are conducted on infants right from birth and continue until they are 2 years old. 

The purpose of these tests is to eliminate any vision abnormalities or potentially life-threatening conditions such as refractive errors, strabismus, cataracts and or retinoblastoma, a rare childhood cancer that originates in the eye.  In order to be classified as typical, a red reflex must appear in shades of red or orange and must be evenly displayed in both eyes. An absent red reflex can be identified by its white appearance, reduced visibility on one side, or absence altogether. 

What is the red reflex?

According to the Cleveland Clinic, the red reflex is the normal reddish coloration of the pupils that’s visible when light shined into your pupil reflects off the inside of your eye. Being a new mom entails a multitude of unfamiliar concepts to grasp and adapt to. It was only through my personal encounter that I became aware of the significance of the red reflex in a newborn’s eye health.

My Newborn’s Experience

At my baby’s one-month check-up, the regular wellness visit went as usual. The pediatrician came in and performed the usual examination. I mentioned that my baby seemed to react to colors by how he was moving his eyes towards colored objects. The pediatrician used a special tool called an ophthalmoscope to examine his eyes with light, and then repeated the process.

I was completely unaware of what I would hear next. After examining him, she glanced at me and mentioned that something appeared to be wrong. Upon retesting his eyes, she informed me that she was not detecting his red reflex. In response, I immediately asked for more information. She explained that she had examined it during his previous appointment and was planning to re-test it during this visit.

She proceeded to describe what a red reflex was and expressed her concern about not seeing it in either of his eyes, or perhaps only partially in one eye. Typically, this indicates that there may be an issue obstructing his vision, such as a cataract, which would probably require surgery to rectify.

However, she did mention that there is a possibility of being wrong, so she advised me to double-check with a specialist and make sure that everything is alright. I couldn’t help but wonder, he’s just a baby, why would a newborn need surgery?

My heart sank! And plummeted. I couldn’t focus from there on out.

I inquired about the course of action I should take. She gave me a referral to see an eye specialist. I saw this as a serious issue. I had recently given birth to my baby. Is it possible that my baby could be blind? When I returned home that day, I felt an overwhelming sense of numbness, which led me to quickly search on Google to find out more about this particular condition. In the afternoon, I made an appointment for him to visit the ophthalmologist.

I had to wait the entire week because the earliest appointment available was on the following Monday. And let me tell you, it felt like the longest week ever! Reading certain information filled me with anxiety at the thought of my baby experiencing similar challenges at such a young age. Especially reading about something life threatening like retinoblastoma. 

Over the weekend, I couldn’t help but cry as I searched online, looking for people who have gone through similar experiences. When I looked at my infant, I disregarded the negative thoughts and reminded myself to be strong for him. 

On Monday, we visited the eye specialist who gave him some drops to dilate his pupils. It took two rounds of drops and around 30 minutes for his pupils to enlarge. The doctor conducted his examinations, utilizing more specialist equipment. He monitored my baby’s eye movements and conducted additional tests. It turned out that his eyes are good, with no obstructions affecting his vision, and the doctor was able to see his red reflex. I felt a wave of relief and happiness rushed through me when I found out my baby was safe and healthy.

Summary

If the pupils are too small to permit light to pass through into the eye, it will lead to the absence of a red reflex. Babies with darker skin may show a green or blue reflex instead of red, and in some cases, there may be no red reflex at all. 

Abnormal red reflexes can sometimes be seen in flash photos of children. It’s important to always be attentive to our little ones, and if you notice anything unusual, it’s best to talk to their healthcare providers.

References

“Red Reflex(Fundus Reflex.” Cleveland Clinic, 11/10/2023, https://my.clevelandclinic.org/health/articles/red-reflex-fundus-reflex. 6/9/2024.