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The Brückner Test Revisited

  • Chapter
Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Core Messages

  • The Brückner test is useful to detect various amblyogenic disorders. After a short training, every physician can perform the test.

  • The test as originally described consists of four elements to observe: (1) the position of the first Purkinje images (corneal light reflexes), (2) the fundus red reflex in the pupil, (3) pupillary light reflexes, and (4) any movement of the eyes when illumination alters from one eye to the other.

  • Asymmetry in corneal light reflexes on both eyes may indicate strabismus. However, small deviations are not reliably detected, and asymmetry can also be caused by different angle kappa in both eyes.

  • Performance of the red reflex test requires a direct ophthalmoscope. Substitution by an otoscope, indirect ophthalmoscope, or any other light source causes loss of test validity.

  • The red reflex test allows for detection of refractive error, strabismus and organic disorders such as opacities of the optic media and distinct pathologies of the fundus.

  • Media opacity is easily detected at a test distance of 0.3 m and less, examining each eye separately. Any optically relevant opacity will be apparent by a shadow in the red reflex.

  • Detection of refractive error can be improved by extending the test distance up to 4 m and observing the brightness of the red reflex in both eyes simultaneously. While usually at a distance of 1 m, the red reflex is brighter in the more ametropic eye, the reflex in this eye becomes increasingly darker with increasing test distance. With increasing test distance, myopia and hypermetropia, which are not compensated by accommodation, cause significant dimming, and anisometropia causes increasing asymmetry.

  • The test sensitivity to detect microstrabismus by asymmetric fundus red reflex is low.

  • Testing pupillary light reflexes is recommendable to assess visual afference, pupillomotor efference and pupil responsiveness. It is hardly suitable to diagnose or exclude amblyopia and amblyogenic disorders.

  • Testing for fixation movements caused by switching illumination from one eye to the other is similar to the cover test. Data on diagnostic validity of this procedure are lacking.

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Authors and Affiliations

  1. Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen Campus, Friedrichstraβe 18, 35385, Giessen, Germany

    Michael Gräf

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  1. Michael Gräf
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Editors and Affiliations

  1. Klinik und Poliklinik für Augenheilkunde, Justus-Liebig-University UKGM GmbH Giessen Campus, Friedrichstraße 18, Giessen, 35392, Germany

    Birgit Lorenz (Professor of Ophthalmology) (Professor of Ophthalmology)

  2. Department of Ophthalmology, Professor of Ophthalmology and Neurology Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Michael C. Brodsky

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Gräf, M. (2010). The Brückner Test Revisited. In: Lorenz, B., Brodsky, M.C. (eds) Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85851-5_9

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  • DOI: https://doi.org/10.1007/978-3-540-85851-5_9

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