Pseudoexotropia Clinical Presentation

Updated: May 12, 2021
  • Author: Barbara L Roque, MD, DPBO, FPAO; Chief Editor: Donny W Suh, MD, MBA, FAAP, FACS  more...
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Parents usually report a perception that their child's eyes are turned out. Review of the birth history including gestational age at birth, birthweight, and history of treatment for retinopathy of prematurity are diagnostic clues. A photograph taken during the first few months of life can help in documenting the onset as well as the stability of the pseudoexotropia. 



Patients appear to have a large angle kappa or nasally deviated corneal light reflex. Cover testing does not show any refixation movement in patients with pseudoexotropia, as opposed to in patients with true exotropia.

Orthoptic exam will show a notable difference between the prism and alternate cover test and the Hirschberg measurements. [5] This suggests that angle kappa can exaggerate or even conceal the true amount of the true heterotropia.  

In the case of macular ectopia, an indirect ophthalmoscope reveals temporal displacement of the macula.



A common cause of pseudoexotropia is a temporally displaced or dragged macula (macular ectopia) as seen in the cicatricial sequelae of retinopathy of prematurity. [2, 4]  Retinal scarring in the temporal periphery caused by chorioretinal infection with Toxocara canis is another cause of a temporally displaced macula resulting in pseudoexotropia. Macular ectopia can also be seen in cases of high myopia and congenital reitnal folds.





Physical Examination

Certain morphological features of the face can produce a false sense of perception of ouwardly deviated eyes, such as hypertelorism and telecanthus. [3]