The newborn eye examination can be difficult immediately after birth, when the face may be edematous, and an assistant may help to hold the eyelid open. The sclera should be white but may appear a faint blue in premature infants. The pupils should be symmetric and reactive. A red reflex (reflex off the retina as viewed through ophthalmoscope) should be present bilaterally. In dark-skinned infants the retinal reflex can appear pale or grayish white (Tappero and Honeyfield,

2003). Absence of a retinal reflex can indicate a congenital cataract, and a bright white or asymmetric reflex may be seen with retinoblastoma. Subconjunctival hemorrhage can be seen, more frequently with traumatic labor or delivery, and often clears within the first few days of life. Prominent epi-canthal folds over the medial upper aspect of the eye can be seen in Down syndrome but can also be a familial trait.

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