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Pseudostrabismus
If the epicanthus increases in
width and obscures the inner canthus, this may create the
appearance of esotropia - sometimes Apparent large angle esotropia - when none is actually present .
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 this early age, it is difficult to do a cover-uncover
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 esotropia that is caused by the wide
nasal skin folds partially or completely obliterating view of the nasal white
conjunctiva.
When you examine a case of pseudostrabismus, 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
Identical corneal points
In spite of the apparent deviation, the corneal
light reflex is at identical corneal points denoting the pseudostrabismus
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