Pseudoesotropia

Author: Kalpana K Jatla, MD; Chief Editor: Hampton Roy Sr, MD more...

Updated: Nov 29, 2011

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Background
Pathophysiology
Epidemiology
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Background

Pseudoesotropia is a condition in which the alignment of the eyes is straight (also known as orthotropic); however, they appear to be crossed.^[1]

Note the cross-eyed appearance of the right eye in the top image that corrects with elimination of the prominent epicanthal fold.

In these photos of the same child as in the previous image, note the cross-eyed appearance of the left eye in the top image that corrects with elimination of the prominent epicanthal fold. Also, note that corneal light reflex demonstrates straight alignment.

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.^[2]

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.

Proceed to Clinical Presentation

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, MBA, MSS Professor, Department of Ophthalmology, University of Colorado School of Medicine; Chairman, Department of Ophthalmology, Children's Hospital

Robert William Enzenauer, MD, MPH, MBA, MSS is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and American College of Physician Executives

Disclosure: Clear Donor Consulting fee Consulting; Clear Donor Salary Employment

Specialty Editor Board

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, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

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.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

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.

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.

References

Catalano RA, Nelson LB. Pediatric Ophthalmology: A Text Atlas. 1994;25, 94-95.
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].
Wright K. Pediatric Ophthalmology and Strabismus. 1995;192.

Note the cross-eyed appearance of the right eye in the top image that corrects with elimination of the prominent epicanthal fold.

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