Family Nurse Practitioner Exam

During a well child visit, what condition should be ruled out if a white reflection is seen in a child's pupil while checking for the red reflex?

1. Unilateral strabismus

2. Unilateral cataracts

3. Retinoblastoma of the left eye

4. Color blindness of the left eye

The correct answer is: Retinoblastoma of the left eye

In the scenario described, a white reflection seen in a child's pupil during the assessment for the red reflex may indicate a serious underlying condition, most notably retinoblastoma. The absence of a normal red reflex (which typically appears red due to the retina's vascular supply) and the presence of a white reflection (leukokoria) can be a key sign of retinoblastoma, a malignant tumor of the retina that typically affects children. Prompt identification and referral for further evaluation are critical, as retinoblastoma requires timely treatment to optimize visual outcomes and address any potential metastasis. The assessment of the red reflex is a crucial part of pediatric eye examinations, as it can help in early detection of various eye conditions. In contrast, conditions like unilateral strabismus may affect visual alignment but would not present with a white pupil reflection during this test. Unilateral cataracts can also cause a white reflection but are less commonly indicated solely by this finding compared to retinoblastoma, which is much more urgent in nature. Color blindness does not cause any changes in the appearance of the pupil or the red reflex itself. Therefore, identifying retinoblastoma as the leading concern when observing a white reflection in the pupil underscores the importance of thorough eye examinations