Pseudo Strabismus Explained

Information for patients from the Head & Neck Directorate

What is a pseudostrabismus?
A pseudostrabismus or pseudosquint is the appearance of a deviating eye. It may look as though
one or both eyes appear to turn in, out, up or down; but in fact the eyes are straight.

Pseudostrabismus (above) - The light reflections (white dots) are in the centre of the eye.

True strabismus (squint) (above) – The light reflection (white dot) is on the edge of the coloured
part of the child’s left eye and in the centre of the child’s right eye. The above picture refers to a
left convergent squint.
What causes a pseudostrabismus?
The most common cause is epicanthus which are prominent folds of skin over the inside corner of
the eye. Epicanthus is often associated with a flat bridge of the nose.

However, other causes of pseudostrabismus include:

• a large distance between the eyes
• a narrow distance between the eyes
• different coloured eyes
• asymmetrical lid positions

Is it common?
Yes. Many babies have a pseudostrabismus.

What is the treatment?

No treatment is necessary. As your child grows the bridge of the nose will develop and the
pseudostrabismus will become less apparent.

Assessment of your child

The appointments with the orthoptist are for observation of your child. The orthoptist will check
your child’s vision, testing the sight of each eye in turn. The orthoptist will ensure he/she doesn’t
have a true strabismus (squint). This will be done by looking at how their eyes work together
(binocular vision), using tests to demonstrate certain reflexes and 3D vision (this test is called
stereopsis). Your child will remain under observation until an accurate measurement of vision in
either eye can be obtained which may be 2.5 – 3.5 years old.

Testing for glasses

If there is a family history of glasses from a young age or a history of a true strabismus, then a test
for glasses (refraction) will be done by an optometrist (optician) or an ophthalmologist (eye doctor).

Benefits of assessment
The main benefit is peace of mind, knowing your child’s vision is good and that he/she doesn’t
have a true squint. If this is not the case we will be able to advise you on the best treatment for
your child.

Risks of not having assessments for pseudostrabismus

A squint can occur in children who have an eye deviation and can cause significant defects in
vision if not treated, so assessment at a young age is important. A squint can develop in children
who had a pseudostrabismus as a baby.

Future vision assessments

All children are offered:
• a vision screening assessment at 3 ½ years old by an orthoptist at your local health centre
• a vision test at 4 ½ - 5 ½ years old by the school nurse
• free eye examinations by an optometrist until the age of 16 years
Glossary
• Epicanthus - Prominent folds of skin over the inside corner of the eye.
• Optometrist (optician) - A person who tests people for glasses and also makes and fits
them.
• Ophthalmologist - A doctor who specialises in the diagnosis and treatment of eye
diseases.
• Orthoptist - A person who specialises in the detection and management of eye
movement disorders.
• Pseudostrabismus/ pseudosquint -The appearance of an eye deviation, often due to
epicanthus or facial asymmetry. Not a true squint.
• Strabismus/squint - A manifest or latent ocular deviation i.e. a constant turn or a tendancy
for an eye to turn.
• Convergent - Eye turns in.
• Divergent - Eye turns out.
• Vertical - Eye turns up or down.

References
• https://secure3.aoo.org/pdf/051076.pdf

This leaflet has been produced with and for patients

Information produced by the Head & Neck Directorate

Date of production: September 2009 Web019