Hirschberg test

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Hirschberg test

The Hirschberg test, also known as the corneal light reflex test, is a simple clinical method used to assess the presence and degree of strabismus (ocular misalignment). This test is commonly performed in both pediatric and adult patients to evaluate the alignment of the eyes.

Procedure

The Hirschberg test is performed by shining a light source, such as a penlight, directly into the patient's eyes while they are instructed to look at the light. The examiner observes the reflection of the light on the corneas of both eyes. In a normally aligned eye, the light reflex will appear symmetrically centered on both corneas. If there is a misalignment, the light reflex will be displaced from the center of the cornea in one or both eyes.

Interpretation

The position of the light reflex can indicate the type and degree of strabismus:

• If the light reflex is displaced nasally (towards the nose), it suggests exotropia (outward deviation).
• If the light reflex is displaced temporally (towards the ear), it suggests esotropia (inward deviation).
• If the light reflex is displaced superiorly (upward), it suggests hypotropia (downward deviation).
• If the light reflex is displaced inferiorly (downward), it suggests hypertropia (upward deviation).

The degree of displacement can be used to estimate the angle of deviation. Each millimeter of displacement roughly corresponds to 7 degrees of ocular misalignment.

Clinical Significance

The Hirschberg test is a quick and non-invasive method to screen for strabismus, which can lead to amblyopia (lazy eye) if left untreated. Early detection and treatment of strabismus are crucial for preventing long-term visual impairment. The test is often used in conjunction with other diagnostic tools such as the cover test and the prism cover test to provide a comprehensive assessment of ocular alignment.

Limitations

While the Hirschberg test is useful for initial screening, it has limitations. It may not detect small degrees of strabismus or differentiate between different types of strabismus. More precise measurements and diagnostic tests, such as synoptophore or ophthalmic ultrasonography, may be required for a detailed evaluation.

Related Pages

• Strabismus
• Amblyopia
• Cover test
• Prism cover test
• Synoptophore
• Ophthalmic ultrasonography

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