Pseudoestropia

Many parents take their children to pediatric eye specialists, known as Pediatric Ophthalmologists, when their child shows symptoms of being cross-eyed or having a lazy eye. Many children actually do not have a lazy or crossed eye, but have a harmless condition called Pseudoestropia. Pseudo has the definition of false, while Esotropia means cross-eyed.

What Is Pseudoesotropia?
Pseudoesotropia is a medical term to describe one who appears to have crossed eyes or a lazy eye, but who actually has normal vision. One or both eyes appear to not be straight, however, most of the time it is an optical illusion created by the width and flatness of the nose. In babies, these nose features can hide a portion of the white of the eye, which can make it seem as if the eyes are crossed.

What Are The Symptoms Of Pseudoesotropia?
The only symptom of Pseudoesotropia include one or both eyes that do not appear straight. The pupil and iris may drift toward the nose, making it seem as if the child is crossing one or both of their eyes.

How Does A Doctor Diagnose Pseudoesotropia?
The doctor will perform some eye tests on your baby using toys, lights, and lenses to determine if your child is truly cross-eyed. It is painless and many children will think they are playing a game. Although eye drops are sometimes used, this does not cause your baby any pain.

The secret to determining if a child has Pseudoesotropia is not to look at the position of the pupils and iris, but to look at where in the pupil the reflection is. In most cases of Pseudoesotropia, the reflection of a flashlight or penlight will show the reflection to remain in the middle of the pupils, which is where it is supposed to be. If the reflection leans toward the iris itself, then Esotropia is a probable diagnosis and more testing will have to be done.

Babies appearing cross-eyed is very common in newborns, especially if they are trying to focus on something very close or at an angle. For this reason, many Pediatric Ophthalmologists will not see children until they are 6 months old to ensure an accurate diagnosis.

What Is The Treatment For Pseudoesotropia?
Your grandparents may tell you that crossed or lazy eyes can be corrected by having your baby do simple eye exercises. Several decades of research on these exercises prove them to be ineffective. In fact, many children that were diagnosed with Esotropia years ago probably were not cross-eyed at all. They most likely had Pseudoesotropia, which is why their parents thought the eye exercises were helping, but what was really happening is as they aged and their noses started growing out and narrowing, that the optical illusion of crossed eyes dissipated.

Pseudoesotropia does not require any treatment because the nose will grow and the optical illusion of crossed eyes will fade. If a child does truly have crossed eyes, then they will either require surgery, an eye patch, or glasses with corrective lenses.

Can I Prevent Pseudoesotropia?
There is no known way to prevent Pseudoestropia and parents should rest assured that they did nothing during the pregnancy to cause this condition.

Sometimes a child will actually have crossed eyes, or Esotropia, which can cause vision problems and may even cause them to lose sight in the affected eye if it is not treated with surgery, glasses, or an eye patch. Any concerns about your child's vision should be directed to your pediatrician immediately. After an exam, a referral may be made with a Pediatric Ophthalmologist for proper diagnosis and treatment.

Sources:

James L. Mims III, M.D. and Gale Morrow, M.P.H., "Is This The Real Thing", Pseudoestropria Information Booklet