Pseudostrabismus (Pseudoesotropia)

The parents of this 5-month-old boy were concerned that his eyes were turned in toward the nose. The infant was otherwise healthy. Physical findings were normal. In particular, when a light source was projected onto the eyes, the light reflex was centered in both eyes.

The child has pseudostrabismus (pseudoesotropia)—the false appearance of strabismus when, in fact, the eyes are orthotropic. The appearance may result from a flat and broad nasal bridge, prominent epicanthal folds, or a narrow interpupillary distance.

The condition is more common in Asian children. With pseudostrabismus, the corneal light reflex is centered in both eyes and the alternate cover test shows no refixation movement.

The converse is true for strabismus. The prognosis is excellent; most children with pseudostrabismus outgrow the condition.

(Case and photograph courtesy of Alexander K. C. Leung, MD and Justine H. S. Fong, MD.)