Hirschbergtest

The Hirschberg test is a quick clinical method used to estimate ocular alignment by assessing the position of the corneal light reflex in each eye. It provides a rough measurement of strabismus and is commonly used in pediatric and general ophthalmology screening to detect manifest deviations and screen for misalignment in infants and uncooperative patients.

To perform, the patient fixates a distant target (or a near target if appropriate) while the examiner shines a light source, typically a penlight, onto the eyes from about 33–50 cm. The examiner observes the corneal light reflexes and compares their position within each pupil. In normal alignment, the reflexes are centered and symmetric. If the reflexes are displaced, the eyes are not perfectly aligned; the deviation can be roughly estimated from the amount and direction of reflex offset, usually measured in millimeters from the pupil center.

The test serves as a screening tool for strabismus and ocular misalignment, particularly in children or non-cooperative patients. It is often part of a basic ocular motility examination and can guide further testing with cover tests or prism-based methods (such as Krimsky or alternate cover tests) to quantify the deviation.

Limitations include its qualitative nature, dependence on proper lighting and fixation, and the fact that it provides only an approximate estimate of deviation. It can be influenced by small pupil size, glasses, or anisometropia, and typically must be followed by more precise procedures for diagnosis and management.

Named after Hirschberg, who described the method in the early 20th century, the test remains a foundational observational tool in ophthalmology.