The perception of strabismus and misalignment of the eyes, despite their proper alignment, is termed pseudostrabismus. This condition may arise due to an optical illusion caused by certain facial structural features. The most commonly seen type of pseudostrabismus is when the eyes appear crossed, known as pseudo-esotropia. Less common situations include the illusion of the eyes turning outward or not being vertically aligned.
What is Pseudostrabismus?
Pseudostrabismus is a condition where the eyes do not actually misalign but appear as if they do, and it can occur in infants and young children.
As infants' facial anatomy has not fully developed, their nasal bridges are flat, and the skin around the eyes is folded, which can create the impression of inward eye misalignment. This appearance may reduce as children grow and their facial features mature. Additionally, structural differences in the eye spheres or the alignment of the visual axis with the geometric axis can also lead to strabismus-like symptoms in children.
Why Does Pseudostrabismus Occur in Infants and Children?
Pseudostrabismus in infants and young children is usually due to anatomical features of the face. It is particularly more frequent in the following situations:
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A broad and flat nasal bridge: Makes the distance between the eyes appear closer and creates the impression of eye misalignment.
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Epicanthic fold: The fold of skin from the upper eyelid covers part of the inner eye corner.
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Eyelid structure: The structural visibility of the sclera may be less, giving the impression of eye misalignment during a child's gaze. This anatomical appearance is usually more prominent during infancy and early childhood.
As children grow, facial proportions change. The nasal bridge becomes more pronounced, the eye area takes on a more mature shape, and with this developmental process, the appearance of pseudostrabismus typically diminishes or disappears entirely. Over time, with changes in facial anatomical features, such optical illusions naturally resolve.
Does Pseudostrabismus Lead to Amblyopia?
Pseudostrabismus is solely a cosmetic issue and may not cause amblyopia. However, in cases of true strabismus, amblyopia may develop. For this reason, even conditions thought to be pseudostrabismus should undergo periodic eye examination.
In the event of eye misalignment observed in infants, they should be promptly examined by a doctor. Since infants' eyes are still in the development process, failing to intervene early in such cases can lead to permanent issues or complications. Parents should regularly check their infants' eye movements and consult a specialist when they notice abnormalities.
How to Distinguish Between Pseudostrabismus and True Strabismus?
Distinguishing between true strabismus and pseudostrabismus can sometimes be challenging. Eye doctors can clarify the diagnosis through a light reflex test and an eye movement examination. The following signs indicate true strabismus:
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One of the eyes consistently looking in a different direction
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Tilting the head
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One of the eyelids being lower
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Signs of amblyopia
How is a Pseudostrabismus Examination Conducted?
Routine Eye Examinations
Individuals presenting with complaints of pseudostrabismus may undergo routine tests, such as visual and retinal examinations. This type of complaint is among the commonly encountered cases, and standard procedures for eye examination are applied when assessing these patients.
Hirschberg Test
The Hirschberg test examines the reflections of light in the eyes. The analysis of eye movements includes examining each eye in nine different gaze directions.
Three-Dimensional Vision Test
Once infants develop their speaking abilities, a three-dimensional vision test can be conducted. This test detects the presence of strabismus. Red-green glasses and special cards are used for the test.
Cover Test
Changes occurring when covering one eye and disrupting visual harmony with the other eye are assessed. Subsequently, the covered eye is unveiled, and any movement in this eye is evaluated.
Frequently Asked Questions
When does pseudostrabismus completely resolve in infants?
Pseudostrabismus may improve as the facial structure of infants develops. It begins to diminish in prominence between the 6th and 12th month and fully resolves in most children around the age of 2–3. However, if the misalignment becomes more pronounced or appears permanent, an eye examination is necessary.
Does pseudostrabismus cause amblyopia?
No, pseudostrabismus is purely cosmetic and does not cause amblyopia on its own. However, the risk of amblyopia development is higher in true strabismus. Therefore, doctor examination is important in every case.
Why does pseudostrabismus occur in adults?
Pseudostrabismus is rarely seen in adults. It may occur primarily due to nasal bridge width or eyelid shape, creating an impression of eye misalignment. If there is a suspicion of misalignment in adults, the possibility of true strabismus should definitely be investigated.
When does pseudostrabismus resolve?
As the infant grows, the facial structure settles, and the appearance of pseudostrabismus resolves. However, a specialist evaluation is necessary for differential diagnosis.