You are in: eMedicine Specialties > Ophthalmology > EXTRAOCULAR MUSCLES Esotropia, PseudoArticle Last Updated: May 18, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Kalpana K Jatla, MD, Fellow in Glaucoma, Department of Ophthalmology, Wills Eye Hospital Kalpana K Jatla is a member of the following medical societies: American Academy of Ophthalmology Coauthor(s): S Anna Kao, MD, Staff Physician, Department of Ophthalmology, West Georgia Medical Center; Kenneth T Horlander, MD, Consulting Staff, Department of Pulmonary and Critical Care Medicine, West Georgia Health System; Robert William Enzenauer, MD, MPH, Professor, Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center Editors: Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas; Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles; J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida; Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences Author and Editor Disclosure Synonyms and related keywords: pseudoesotropia, pseudostrabismus, crossed eyes INTRODUCTIONSection 2 of 10
  BackgroundPseudoesotropia is a condition in which the alignment of the eyes is straight (also known as orthotropic); however, they appear to be crossed. PathophysiologyThis condition most commonly occurs in infants when a flat nasal bridge and prominent epicanthal folds tend to obscure the nasal portion of the sclera. This optical illusion causes the patient to have an appearance of eyes deviated nasally, and it is most apparent when the eyes are in side gaze or are focusing up close. A small interpupillary distance (ie, the distance between 2 pupils) also can give the appearance of pseudoesotropia. FrequencyUnited StatesPseudoesotropia is a condition with variable frequency. This condition is one of the most common reasons for infant referrals to ophthalmologists. RaceInfants or young toddlers of Asian descent with flat nasal bridges often have this condition. SexNo gender predilection exists in this condition. AgePseudoesotropia is more frequent in infants and toddlers where facial structures have not yet fully developed. CLINICALSection 3 of 10
HistoryParents may notice that their young child's eyes appear to turn in. The deviation is reported to be even more noticeable when the child has a head turn and the eyes are in lateral gaze. Parents may bring pictures showing how the eyes are "turned in" to the ophthalmologist. Physical
CausesA flat nasal bridge with wide epicanthus or a small interpupillary distance obscures the nasal portion of the sclera. One paper reported 4 cases of pseudoesotropia caused by a negative angle kappa, a nasally dislocated macula in infants with high myopia. DIFFERENTIALSSection 4 of 10
Esotropia and Exotropia, A-patterns Esotropia and Exotropia, V-patterns Esotropia, Accommodative Esotropia, Acquired Esotropia, Infantile Esotropia, with High AC/A Ratio WORKUPSection 5 of 10
Other Tests
TREATMENTSection 6 of 10
Medical CareNo treatment is required for pseudoesotropia. Parents can be reassured that their child most likely will outgrow the condition. Infants should be observed and reevaluated every 6 months because it is possible that true esotropia, particularly accommodative esotropia, may develop at a later date. ConsultationsPatients with suspected pseudoesotropia should be examined and receive follow-up care by an ophthalmologist since it is possible that true esotropia may develop at a later date. FOLLOW-UPSection 7 of 10
Further Outpatient Care
Prognosis
Patient Education
MISCELLANEOUSSection 8 of 10
Medical/Legal Pitfalls
MULTIMEDIASection 9 of 10
REFERENCESSection 10 of 10
Article Last Updated: May 18, 2006 | |||||||||||||||||||||
