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Pseudostrabismus

What is pseudostrabismus?

Strabismus is the medical term for eye misalignment. Pseudostrabismus refers to a false appearance of strabismus. Most often the eye(s) has the false appearance of turning inward [See figure 1].

Fig. 1 Most often in pseudostrabismus the eye(s) have the false appearance of turning inward.

Why do some children's eyes look crossed?

The skin fold at the inner corner of the eyelids can be broad and is often associated with a broad flat nasal bridge (epicanthal folds or epicanthus). These features contribute to a cross eye appearance since there is less space (white area) between the iris and the inner corner of the eyelid. This is especially noticeable in pictures.

How does a doctor determine if a child has true strabismus or pseudostrabismus?

The Eye MD determines if the light reflexes from each eye are centered. The light should fall symmetrically within the pupils. If a true strabismus is present the light reflexes do not fall on the same position of each eye. A cover test (occluding one eye and then the other) confirms the findings.

Why is it important to differentiate pseudostrabismus from true strabismus?

True strabismus in a child can lead to permanent vision loss and is best treated early. If a child is suspected of having strabismus, an Eye MD evaluation is important. It may be difficult for a pediatrician to differentiate between true strabismus and pseudostrabismus.

What is the treatment of pseudostrabismus?

Pseudostrabismus does not require treatment and the appearance tends to improve with time. As facial features mature, the widened nasal bridge tends to narrow. Asian children may retain a broad nasal bridge into adulthood. Surgery is rarely required for cosmetic reasons.