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When the epicanthus increases in
width and obscures the inner canthus, it may create the
appearance of esotropia - sometimes Apparent large angle esotropia - when none is actually present .This
is a common cause of
pseudostrabismus.
In time, the bridge of the
nose develops,
and in whites the epicanthal fold normally disappears.
The examiner may demonstrate to anxious parents that
pseudostrabismus disappears by lifting the skin from the
nasal bridge , of course this is not allowed by most
infants
In a case like this it is difficult to do a cover test
to confirm the alignment. In place of the cover test it is
important to observe the corneal light reflex. If the
light reflex is in the centre of the pupil when the
infant looks straightforward or it is at identical corneal points in different directions of
gazes , it
is likely that the eyes are aligned in spite of the
apparent large esotropia that is caused by the wide
nasal skin folds obliterating view of the nasal white
conjunctiva.
When you examine a case of pseudo strabismus, it is
important to do a thorough eye examination to confirm the
alignment of the eyes , reassure the parents and offer
the family a plan to follow up later
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