<P> It is difficult to assess the effectiveness of the technique due to the low incidence of some of the pathology the red reflex is used to detect . For example, retinoblastoma, a neuroblastic tumor that can cause a dampened or even white reflex, occurs in 1 in every 20,000 children . Regardless of the effectiveness, it is a fast, inexpensive, and noninvasive exam that could identify ocular pathology which with early identification can alter the course of the disease . </P> <P> There are two techniques used to assess the red reflex listed below . Both are noninvasive, inexpensive, and quick . It should be noted that dilation of the eyes is unnecessary and not recommended due to the theoretical but rarely seen risks of sympathmimetics and antimuscarinic systemic effects--tachycardia (fast heart rate), hypertension (high blood pressure), and arrhythmia (abnormal heart rhythm). </P> <P> The traditional red reflex refers to visualizing each eye individually . The American Academy of Pediatrics describes using a direct opthalmoscope with a lens at 0, approximately 18 inches away in a dimly lit room on each eye . </P> <P> The Bruckner test differs in that one will visualize both eyes simultaneously . Unlike the red reflex, this can help determine if the patient has normal ocular alignment . In order to perform this test the patient and physician are normally approximately 2 to 3 feet away from each other . </P>

When would the pupillary reflex not be observed