Pseudo strabismus ( Apparent Esotropia )
18 month old boy
Vision: fixes and follows with both eyes
Refraction: OD +1.00 OS +1.00
This 18 month old boy was noted by his parents to have crossed eyes beginning shortly after birth. The pregnancy and delivery were normal. He is developing normally. The eye examination is normal except for the esotropia
When the epicanthus increases in width and obscures the inner canthus, it may create the appearance of esotropia - sometimes Apparent large angle esotropia - when none is actually present .This is a common cause of pseudostrabismus.
In time, the bridge of the nose develops, and in whites the epicanthal fold normally disappears. The examiner may demonstrate to anxious parents that pseudostrabismus disappears by lifting the skin from the nasal bridge , of course this is not allowed by most infants
In a case like this it is difficult to do a cover test to confirm the alignment. In place of the cover test it is important to observe the corneal light reflex. If the light reflex is in the centre of the pupil when the infant looks straightforward or it is at identical corneal points in different directions of gazes , it is likely that the eyes are aligned in spite of the apparent large esotropia that is caused by the wide nasal skin folds obliterating view of the nasal white conjunctiva.
When you examine a case of pseudo strabismus, it is important to do a thorough eye examination to confirm the alignment of the eyes , reassure the parents and offer the family a plan to follow up later
Identical corneal points
In spite of the apparent large deviation the corneal light reflex is at identical corneal points denoting the pseudostrabismus
( Notice the large epicanthal fold obescuring the inner canthus of the Rt eye )
By : Dr.Gamal Sobhy
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