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OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 884

Brückner's test for squint explained - A hypothesis


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Amber Amar Bhayana
Dr Rajendra Prasad Centre, AIIMS, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_606_21

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How to cite this article:
Bhayana AA, Prasad P. Brückner's test for squint explained - A hypothesis. Indian J Ophthalmol Case Rep 2021;1:884

How to cite this URL:
Bhayana AA, Prasad P. Brückner's test for squint explained - A hypothesis. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 18];1:884. Available from: https://www.ijoreports.in/text.asp?2021/1/4/884/327702



In case of esotropia/exotropia [Figure 1]a, the path of light traveled for the reflex formation is normal in the non-deviated eye (black line, [Figure 1]c), but is shorter in the deviated eye (green line instead of the normal black line—chord instead of diameter considering the eye cross-section to be a circle, [Figure 1]b). This results in the apparent shorter axial length to the traversing light in the squinting eye and resultant asymmetric hyperopia apparent in the squinting eye as compared to the normal eye. Hyperopia causes an asymmetric crescent when Brückner's test[1],[2],[3] is done which is seen as an asymmetric brighter reflex (not seen in the normal eye). Roe and Guyton in their article have described “off-axis optical aberrations” in the squinting eye which decreases the conjugacy of the ophthalmoscope to the retina causing light to spillover into the peephole increasing the intensity of the red reflex to increase. Similarly, they have described optical blur in case of anisometropes to cause spillover to peephole when compared to the normal eye which focuses sharply on the mirror rather than peephole, and thus, a brighter reflex in the refractive error eye.[4] We believe it is the apparently induced hyperopia due to the apparent axial length shortening for the straight traversing light in the squinting eye which gives rise to a brighter glow as compared to the normal eye and forms the basis of the famous “Brückner's test.”
Figure 1: (a) Esotropia; (b) Squinting eye-path traveled by light in the Brückner's test is the green line (shorter) instead of the black line (normal); (c) Normal eye-path traveled by light in the Brückner's test is a black line—the normal anteroposterior diameter

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  References Top

1.
Tongue AC, Cibis GW. Brückner test. Ophthalmology 1981;88:1041-4.  Back to cited text no. 1
    
2.
Kothari MT. Can the Brückner test be used as a rapid screening test to detect significant refractive errors in children? Indian J Ophthalmol Case Rep2007;55:213-5.  Back to cited text no. 2
    
3.
Bhayana AA, Prasad P, Azad SV. Refractive errors and the red reflex- Brückner test revisited. Indian J Ophthalmol Case Rep2019;67:1381-2.  Back to cited text no. 3
    
4.
Roe LD, Guyton DL. The light that leaks: Brückner and the red reflex. Surv Ophthalmol 1984;28:665-70.  Back to cited text no. 4
    


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