For the ophthalmoscopic examination, with the newborn awake and eyes open, examine the red retinal (fundus) reflex by setting the ophthalmoscope at 0 diopters and viewing the pupil from about 10 inches. Normally, a red or orange color is reflected from the fundus through the pupil.
A thorough ophthalmoscopic examination is difficult in young infants but may be needed if ocular or neurologic abnormalities are noted. The cornea can ordinarily be seen at +20 diopters, the lens at +15 diopters, and the fundus at 0 diopters.
Examine the optic disc area as you would for an adult. In infants, the optic disc is difficult to visualize but is lighter in color, with less macular pigmentation. The foveal light reflection may not be visible. Papilledema is rare in infants because the fontanelles and open sutures accommodate any increased intracranial pressure, sparing the optic discs.
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