Pseudostrabismus

Pseudostrabismus is the false appearance of misaligned eye.  When the eyes are truly misaligned, the condition is call strabismus.  In strabismus, the eyes can drift in, out, up or down.

In pseudoesotropia, the eyes appear crossed in but are actually straight.  This is common in infants and young children due to their facial structures.  The wide bridge of the nose and small folds of eyelid skin on the nasal side of the eye contribute to this appearance by covering the “white” of the eye on that side.  This is especially noticed when the infant looks to the right or left.  As the child grows, this appearance will improve and disappear.

In pseudoexotropia, the eyes appear to wander out but are actually straight.  It is also often due to facial structures especially in children with wide set eyes.  

How can you tell the difference?

To tell the difference between strabismus and pseudostrabismus, shine a flashlight on your child’s eyes.  When you are certain that your child is looking at the light, observe the light reflection on the surface of the pupil. 

If both eyes are aligned, the light reflection will appear to be in the center of each pupil.  If a child has true strabismus and the eyes are not properly aligned, the reflection will appear in a different location in each eye. (Usually shifted towards the nose, or conversely towards the ear.)  Because the light is not affected by the width of the nose or the folds of eyelids skin a child with pseudostrabismus will have a normal reflection. 

In some cases, the difference between pseudostrabismus and true strabismus can be difficult to detect.  See your ophthalmologist if you have any questions.