What is pseudostrabismus?
Pseudostrabismus is when a person’s eyes look like they are not straight, but they actually are. [See figure 1]. Unlike strabismus, where the eyes are truly misaligned or pointing in different directions, pseudostrabismus is very common in babies and most of them will grow out of this condition on their own.
Fig. 1: In pseudostrabismus, it may seem like the eye(s) have the false appearance of turning inward.
WHY DO SOME CHILDREN'S EYES LOOK CROSSED?
Pseudostrabismus in babies is often caused by their flat nasal bridge and small folds of skin near the inner corners of their eyes (called epicanthal folds). These features make the eyes look crossed even though they are not. This false appearance that the eyes look crossed is more noticeable in pictures when the child looks to the side and the eye is closer to the epicanthal fold, making it appear turned more toward the nose than it should be.
HOW DOES A DOCTOR DETERMINE IF A CHILD HAS TRUE STRABISMUS OR PSEUDOSTRABISMUS?
Eye MD’s/ophthalmologists have different ways to check if the eyes are straight. One simple test is to shine a light onto both eyes and see where the light hits the surface of the eyes. In normal cases, the light should be in the center of each pupil (dark spot in the center of the colored part of the eye) at the same time. If there is strabismus or eye misalignment, the light will not be in the same spot in each eye.
Another test for strabismus is the cover test. During this test, each eye is covered on its own and then the cover is switched to the other eye, while the ophthalmologist watches how the eyes move and focus.
Positive Angle Kappa
Positive Angle Kappa is another form of pseudostrabismus where the light from the exam is not in the center of the pupil while the eye is looking at the light. This gives the false appearance that the eye is turning outward and is another example of pseudostrabismus.
WHY IS IT IMPORTANT TO know the difference between PSEUDOSTRABISMUS and TRUE STRABISMUS?
True strabismus in a child can lead to permanent vision loss and is best treated early. Sometimes it can be hard to tell the difference between true strabismus and pseudostrabismus. If you think your child has strabismus it is important to have them checked by an Eye MD/ophthalmologist.
WHAT IS THE TREATMENT OF PSEUDOSTRABISMUS?
Pseudostrabismus does not need to be treated and often gets better as the child grows and their face changes. In some cases, Asian children may keep a broad nasal bridge as they grow up. However, it is important to note that a baby with pseudostrabismus may get true strabismus as they get older. Regular check-ups with an ophthalmologist are important to keep track of the child's eye health.
More scientific information on pseudostrabismus can be found: