Pseudoesotropia Clinical Presentation

Updated: Oct 14, 2015
  • Author: Kalpana K Jatla, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

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.

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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.

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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.

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