eMedicine Specialties > Ophthalmology > Extraocular Muscles

Esotropia, Pseudo

Author: Kalpana K Jatla, MD, Private Practice, Clarity Eye Center
Coauthor(s): S Anna Kao, MD, Comprehensive Ophthalmologist, Emory Clark Holder Clinic; Staff Physician, Department of Ophthalmology, West Georgia Medical Center; Kenneth T Horlander, MD, Consulting Staff, Department of Pulmonary and Critical Care Medicine, West Georgia Health System and Emory Clark-Holder Clinic; Robert William Enzenauer, MD, MPH, Professor, Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center
Contributor Information and Disclosures

Updated: Nov 14, 2008

Introduction

Background

Pseudoesotropia is a condition in which the alignment of the eyes is straight (also known as orthotropic); however, they appear to be crossed.

See related CME at Highlights of the American Association for Pediatric Ophthalmology and Strabismus Annual Meeting.

Pathophysiology

This condition most commonly occurs in infants when a flat nasal bridge and prominent epicanthal folds tend to obscure the nasal portion of the sclera. This optical illusion causes the patient to have an appearance of eyes deviated nasally, and it is most apparent when the eyes are in side gaze or are focusing up close. A small interpupillary distance (ie, the distance between 2 pupils) also can give the appearance of pseudoesotropia.

Frequency

United States

Pseudoesotropia is a condition with variable frequency. This condition is one of the most common reasons for infant referrals to ophthalmologists.

Race

Infants or young toddlers of Asian descent with flat nasal bridges often have pseudoesotropia.

Sex

No gender predilection exists in pseudoesotropia.

Age

Pseudoesotropia is more frequent in infants and toddlers where facial structures have not yet fully developed.

Clinical

History

Parents may notice that their young child's eyes appear to turn in. The deviation is reported to be even more noticeable when the child has a head turn and the eyes are in lateral gaze. Parents may bring pictures showing how the eyes are "turned in" to the ophthalmologist.

Physical

  • A careful ocular examination (eg, pupillary light reflex) reveals that the eyes are straight.
  • Using the cover-uncover test, the examiner finds that the patient manifests no deviation.
  • A flat nasal bridge with wide epicanthus (the part of skin fold that runs from the upper to the lower eyelids) or a small interpupillary distance usually is noted. Since the nasal scleral portion is being covered by the epicanthus, the examiner can demonstrate the orthotropic appearance by pinching slightly the nasal bridge and revealing the nasal sclera.

Causes

A flat nasal bridge with wide epicanthus or a small interpupillary distance obscures the nasal portion of the sclera.

One paper reported 4 cases of pseudoesotropia caused by a negative angle kappa, a nasally dislocated macula in infants with high myopia.

More on Esotropia, Pseudo

Overview: Esotropia, Pseudo
Differential Diagnoses & Workup: Esotropia, Pseudo
Treatment & Medication: Esotropia, Pseudo
Follow-up: Esotropia, Pseudo
Multimedia: Esotropia, Pseudo
References
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References

  1. Catalano RA, Nelson LB. Pediatric Ophthalmology: A Text Atlas. 1994;25, 94-95.

  2. Damms T, Damms C, Schulz E, et al. [Pseudo-esotropia caused by nasal dislocation of the macula in patients with high infantile myopia]. Ophthalmologe. Feb 1994;91(1):77-80. [Medline].

  3. Wright K. Pediatric Ophthalmology and Strabismus. 1995;192.

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Further Reading

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Keywords

pseudoesotropia, pseudostrabismus, crossed eyes, true esotropia, accommodative esotropia, amblyopia, strabismus

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Contributor Information and Disclosures

Author

Kalpana K Jatla, MD, Private Practice, Clarity Eye Center
Kalpana K Jatla, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

S Anna Kao, MD, Comprehensive Ophthalmologist, Emory Clark Holder Clinic; Staff Physician, Department of Ophthalmology, West Georgia Medical Center
S Anna Kao, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Kenneth T Horlander, MD, Consulting Staff, Department of Pulmonary and Critical Care Medicine, West Georgia Health System and Emory Clark-Holder Clinic
Kenneth T Horlander, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Robert William Enzenauer, MD, MPH, Professor, Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center
Robert William Enzenauer, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Hamilton County Medical Society Salary Consulting

Medical Editor

Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas
Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American College of Surgeons, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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