Very often, parents take their children for an examination in the first year of life due to curvature of the eyes, usually inward, that is, towards the nose.

But is it always true strabismus? The answer is no.

Strabismus is a condition of disturbance of the position or mobility of the eyes in which the two eyes do not have the same direction of vision. The eye that fixes an object is straight, and the other eye can be turned towards the nose (esotropia), outward (exotropia), up (hypertropia) or down (hypotropia).

False strabismus (pseudostrabismus) is a condition where the eyes appear to be crooked, usually towards the nose, but in fact strabismus does not exist. 

False strabismus (pseudostrabismus) is common in babies from birth to 18 months of age. This is because babies have a wide base of the nose and sometimes a fold of skin on the upper lid (epicanthus) that covers the inner part of the white (sclera) and gives the impression that the eyes are crossed/crooked towards the nose.

The illusion that one eye is crooked can be even more pronounced when the baby looks to one side or the other.

False strabismus

It is normal to be concerned that your child may have strabismus. But how to know if it is false strabismus?

A quick and simple way to find out if your child has strabismus is to look at a flash photo of your child.

In the photo, the child’s face and eyes should be directed directly at the camera. See where the light is reflected in your child’s eyes.

If the child has false strabismus, the light will be reflected at the same place on the pupils of both eyes, that is, the light reflex will be central to the pupils.

If the child has true strabismus, the light will be reflected in a different place on each eye, i.e. centrally on the pupil of the eye with which it fixes, while on the eye that curves, the light reflex can be reflected on the edge of the pupil, on the iris or on the sclera.

If the child has false strabismus, the light will be reflected at the same place on the pupils of both eyes, that is, the light reflex will be central to the pupils.

If the child has true strabismus, the light will be reflected in a different place on each eye, i.e. centrally on the pupil of the eye with which it fixes, while on the eye that curves, the light reflex can be reflected on the edge of the pupil, on the iris or on the sclera.

At the examination, the same test can be done by placing a light source in front of the child and following the light reflex of the pupils. A cover/uncover test can also be performed, i.e. a test of covering and uncovering the eyes, which monitors the movement of the eyeballs. In pseudostrabismus, this test is calm – there is no movement of the bulbs, while in strabismus, a movement towards inside/outside or up/down is seen.

What to do if your child has strabismus?

True strabismus tends to worsen over time and requires appropriate treatment (wearing glasses/operative correction). Pseudostrabismus does not require treatment, it improves/disappears over time as the bone structures of the face and nose form as the baby grows.

If you suspect that one or both of your child’s eyes are turning, it is more important to have a detailed ophthalmological examination. Strabismus is corrected by wearing glasses and, if necessary, surgery in order to enable the development of normal vision and visual acuity.

Until next,

dr. Anja Shumejko
doctor