Pseudoesotropia Clinical Presentation

Updated: Mar 02, 2023
  • Author: Kalpana K Jatla, MD; Chief Editor: Donny W Suh, MD, MBA, FAAP, FACS  more...
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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.



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. [3] 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.



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. [4]