Red reflex test is an effective method in early diagnosis of ophthalmic disorders such as cataract, glaucoma, retinoblastoma and retinal diseases. Therefore, early management or referral of patients from neonatologist to ophthalmologist becomes possible.

in this prospective analytic study, neonates who born in Mostafa Khomeini hospital between October 2012 and October 2013 were enrolled. All individuals were examined by a neonatologist on the first day followed by standard ocular examination by an ophthalmologist on the subsequent days.

The results showed that 20.4% of pregnant women had prolonged labor and 27.5% suffered from dystocia (difficult labor). Among neonates, 34.1% had normal red reflex on the first examination and this percent reached to 90.6% on the subsequent examination performed by the ophthalmologist. 65.9% had abnormal red reflex on the first examination which declined to 9.4% in the second examination by an ophthalmologist (p<0.000). Amongst neonates with abnormal red reflex, 31% had ophthalmic disorders including retinal hemorrhage (22.7%), retinal vascular attenuation (3.9%), retinal salt and pepper changes (2.4%) and retinal discoloration (2%). In only 2% of neonates, signs of TORCH syndrome were revealed. Mean Apgar score in neonates with abnormal and normal red reflex were 8.85±1.38 and 9.14±0.213 respectively. No significant correlation between red reflex test and Apgar score was identified (P<0.05).

This study revealed that age, weight and Apgar score of neonate as well as type of labor, labor complications including prolonged labor and dystocia can affect sensitivity of red reflex test. The results of ocular examination made by neonatologist on the first day of birth were significantly different from standard examination performed by an ophthalmologist on the subsequent days. These findings revealed that red reflex test is a sensitive test in early diagnosis of ophthalmic disorders and all neonates must undergo standard examination by an ophthalmologist on preferably third day of birth.