Pseudostrabismus (Pseudoesotropia)

The parents of this 5-month-old boy were concerned that his eyes wereturned in toward the nose. The infant was otherwise healthy. Physical findingswere normal. In particular, when a light source was projected onto theeyes, the light reflex was centered in both eyes.The child has pseudostrabismus (pseudoesotropia)--the false appearanceof strabismus when, in fact, the eyes are orthotropic. The appearancemay result from a flat and broad nasal bridge, prominent epicanthal folds,or a narrow interpupillary distance. The condition is more common in Asianchildren. With pseudostrabismus, the corneal light reflex is centered inboth eyes and the alternate cover test shows no refixation movement. Theconverse is true for strabismus. The prognosis is excellent; most childrenwith pseudostrabismus outgrow the condition.

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