Pseudostrabismus

Pseudostrabismus is the false appearance of crossed eyes.

Symptoms

An infant's eyes may drift in or out at times, but this small variable alignment is perfectly normal during the first few months. When a baby begins focusing on the environment, at about two to three months of age, the eyes should be straight most or all the time.

Esotropia is the name for eyes that turn inward. In pseudoesotropia, the eyes appear to be crossed but are actually straight. This common condition in infants and young children is generally due to the infant's 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. This especially becomes apparent when the infant looks to the right or the left. As the infant's facial structures mature, this appearance of crossing will improve and often disappear.

Exotropia is the name for eyes that turn outward. In pseudoexotropia, the eyes appear to be wandering out but are actually straight. While less common than pseudoesotropia, it also is often due to the facial structures. Children with widely set eyes can appear as if their eyes are drifting out.

Treatment

It is common for parents to be concerned about their child's visual development, especially when they notice what appear to be crossed eyes. Misaligned eyes are a true cause for concern. If left untreated, strabismus can quickly lead to poor visual development in one eye. Unlike Pseudostrabismus, a child does not outgrow true crossing of the eyes. He or she will need ophthalmologic treatment to straighten the eyes and allow for normal vision to develop.

When a child's eyes are actually crossed, he or she will use only one eye at a time to avoid seeing double. The unused or crossed eye may not develop good vision, and become what's commonly called a "lazy" eye (amblyopia). To avoid this condition, the child must be made to use the misaligned eye by patching or covering the good eye.

Tests/Diagnosis

You can do an at-home test to tell the difference between strabismus and pseudostrabismus. Simply shine a flashlight on your child's eyes and observe the light reflection on the front surface of the pupil.

If both eyes are properly aligned, the light reflection will appear in the center of each pupil. Or, the reflection might appear slightly toward the nose in each eye.

If the child has true strabismus and the eyes are not aligned properly, the reflection will appear in a different location in each eye.

Ask your eye doctor to examine your child if you are concerned about misaligned eyes.

Causes/Risk Factors

Pseudostrabismus is common among infants and young children and does not affect vision.