Services for Children

Pseudostrabismus

Some people have eyes that turn inwards, towards the nose – this is called strabismus (more specifically, in-turning of the eyes is esotropia). Other people appear to have strabismus but don’t really – their eyes are actually straight but there is an optical illusion causing confusion; this is a pseudo-strabismus.

When the bridge of the nose is wide it can create the impression that the eyes are turning inwards. We are used to looking at the space between the edge of the cornea (limbus) and the meeting point of the eyelids (canthal angle). When the nasal bridge is wide, the space between the limbus and the canthal angle is small – this also happens when the eye itself is turning inwards, so confusion between the two is understandable. Many children have a flat and wide nasal bridge – as they grow the nose will become narrower and the eyes will no longer appear to cross. Almost all children outgrow this pseudostrabismus.

This child's eyes appear to be crossed. The limbus is close to the canthal angle. However, observe that the camera flash is actually centered in each eye--the eyes are straight. The adjacent photo shows the same child with the bridge of the nose being pinched to take up the excess skin--the distance between the limbus and the canthal angle has increased and the eyes don't look crossed now, do they?

PSEUDOSTRABISMUS VS. TRUE STRABISMUS

The child’s eyes in the photo below are actually crossed. Observe how the reflection of the camera flash is centered within the pupil of the left eye but not centered within the right pupil. You can pinch the nose (gently, of course), but the eyes will still be crossed. This is a true strabismus.