Pseudostrabismus vs Strabismus: Understanding Pediatric Eye Misalignment

Pseudostrabismus and Strabismus: What Every Parent Should Know

Pseudostrabismus and strabismus are two eye conditions that often cause concern for parents of babies and young children. The appearance of crossed eyes can lead to worries about the child’s vision. However, it’s important to know the difference between these two conditions to determine if treatment is needed.

At Cook Vision Therapy, we help parents understand what they’re seeing and ensure their child’s visual development is on track. This article will explain pseudostrabismus, how it differs from true strabismus, and what to do if your child shows signs of eye misalignment.

What is Pseudostrabismus?

Pseudostrabismus refers to the appearance of crossed or misaligned eyes in babies, even though their eyes are properly aligned. It’s a common type of pseudostrabismus that occurs due to facial features, such as a flat nasal bridge or epicanthal folds (small folds of skin near the inner corner of the eyelids). These features make the eyes look crossed, but no real eye misalignment is present.

As a child grows, their facial structure changes, and the appearance of misaligned eyes typically improves. Pseudostrabismus is common in babies and young children, especially those with a broad nasal bridge or prominent folds of skin near the inner corner of the eyes.

While pseudostrabismus can look alarming, it doesn’t cause vision problems. The condition usually resolves with time, and treatment is not necessary.

What Causes Pseudostrabismus?

Pseudostrabismus is often caused by facial features that create the illusion of crossed eyes. The most common factors include:

Epicanthal folds: These small folds of skin cover the inner corner of the eyes and are more prominent in babies, especially those of Asian descent.
Flat nasal bridge: A flat or broad nasal bridge can make the eyes appear closer together, leading to a false appearance of misalignment.
Eyelid shape: Sometimes the upper eyelid partially covers the colored part of the eye (the iris), creating the illusion that one eye is turning inward.

These features are all part of normal facial development and don’t affect the child’s vision. As the baby grows, these features often become less noticeable.

Pseudostrabismus vs. True Strabismus: How to Tell the Difference

It’s important to tell the difference between pseudostrabismus and true strabismus. True strabismus, or misalignment of the eyes, occurs when one eye is turning inward, outward, upward, or downward. In cases of true strabismus, the eyes are genuinely misaligned and can lead to long-term vision problems, including amblyopia (lazy eye) or permanent vision loss if left untreated.

Parents can sometimes notice the difference by observing their child’s eyes during regular check-ups. One way to test for true strabismus at home is to take a flash photo. In a healthy eye, the light reflex will appear in the center of the pupil. If the light is off-center in one eye, it could indicate true strabismus.

However, the best way to determine if your child has strabismus or pseudostrabismus is through an eye exam with a pediatric ophthalmologist. The American Association for Pediatric Ophthalmology and Strabismus recommends regular check-ups to catch any early signs of misalignment.

How Pseudostrabismus is Diagnosed

When diagnosing pseudostrabismus, an eye doctor will perform several tests to assess the position of the eyes and rule out true misalignment. These tests may include:

Light reflex test: The doctor shines a light into the eyes to see where the light reflects off the cornea. In pseudostrabismus, the light will reflect in the same place in both eyes, indicating proper alignment.
Cover test: Another test involves covering one eye to observe how the other eye responds. If the covered eye remains stable when uncovered, it’s a sign of pseudostrabismus.

Your child’s visual development will also be evaluated to ensure there are no underlying refractive errors, such as farsightedness, that could impact their vision.

Is Treatment Needed for Pseudostrabismus?

One of the key differences between pseudostrabismus and true strabismus is that treatment is not required for pseudostrabismus. The appearance of eye misalignment often improves with time as the child’s face and eyes develop.

Regular check-ups with an eye doctor are still important to monitor your child’s visual development. If the child has strabismus, vision therapy or corrective lenses may be recommended to prevent long-term vision issues. In rare cases where the eye is turning outward (pseudoexotropia), more specialized treatment could be considered.

When to Seek Help

Parents often worry about the appearance of crossed eyes in their baby, but pseudostrabismus is usually harmless. However, you should seek help from a pediatric ophthalmologist if:

The appearance of misaligned eyes doesn’t improve by the time the child is 2 or 3 years old.
One eye appears to be misaligned in different directions consistently.
The child is diagnosed with pseudostrabismus but shows signs of vision problems, like difficulty focusing or seeing objects clearly.

True strabismus can lead to more serious complications if not treated early. Eye movements should be observed regularly to catch any signs of true eye misalignment.

The Importance of Early Eye Exams

Even though pseudostrabismus doesn’t require treatment, regular eye exams are crucial for your child’s overall visual health. An eye doctor can monitor for refractive errors like farsightedness or amblyopia, and provide guidance if further intervention is necessary.

At Cook Vision Therapy, we specialize in pediatric vision care and can help diagnose and manage strabismus and other visual challenges. If you’re concerned about your child’s eyes, schedule an appointment today.

Conclusion

Pseudostrabismus refers to the false appearance of crossed eyes in babies and young children, often caused by facial features like epicanthal folds or a flat nasal bridge. While it can look concerning, pseudostrabismus doesn’t affect vision and typically resolves with time. On the other hand, true strabismus is a condition where the eyes are genuinely misaligned and requires medical attention.

Regular check-ups with a pediatric ophthalmologist can help differentiate between pseudostrabismus and strabismus and ensure your child’s visual development stays on track. Contact Cook Vision Therapy today to learn more about how we can support your child’s vision needs.