Brückner test
Also called Bruckner reflex, red reflex comparison, transillumination test
A test that compares the brightness of the red reflex from the two fundi, viewed together through a direct ophthalmoscope held about one meter away, to screen infants and children too young to answer questions for strabismus, anisometropia, opacities of the ocular media and disease of the posterior pole1,4. A fixating eye focuses the light on its fovea and returns a darker reflex; a deviated eye, an eye with a large refractive error, or an eye whose media scatter the light returns a brighter or differently colored reflex2.
When the reflexes are unequal, the brighter eye is the deviated one in strabismus, and the darker eye is the one with the opacity or the higher refractive error3. Unequal reflexes can be normal in infants up to about 10 months of age and false positives occur, so an abnormal result leads to a full examination rather than a diagnosis2,3.
More detail
The examiner works in a dim room at 80 to 100 cm and notes the two reflexes and the corneal reflections together. The test differs from the Hirschberg test, which judges the position of the corneal reflection, although both are read from the same view. It flags a difference in refractive error between the eyes but cannot measure it4.
Sources (4)
- Carlson and Kurtz, Clinical Procedures for Ocular Examination, ch. 2
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 12
- Pickwell's Binocular Vision Anomalies, ch. 3
- Eperjesi and Rundström, Practical Binocular Vision Assessment, ch. 4
Reviewed October 2026