Pseudo Strabismus & When To Worry About True Strabismus

Pseudo Strabismus & When To Worry About True Strabismus

When I was in high school, there was a girl who seemed to suffer from strabismus. As a person with strabismus myself, I assumed for many years that she had crossed eyes. However, it turned out to be false. As I got to know this girl and our confidence grew, one day I asked her about it. She explained that she suffered from pseudo strabismus, meaning she had an apparent strabismus but not an actual eye misalignment.

As a parent, you're constantly observing your child, noticing every little detail. So, it's natural to be concerned if their eyes appear crossed. You might have heard the term "wandering eye" or "squints", and seeing your little one's eyes not quite aligned can be worrying. But what if it's not truly crossed eyes at all? This is where understanding pseudo strabismus becomes crucial. This article will help you understand what pseudo strabismus is, how it differs from true strabismus, and why it's often a normal part of a child's development.

Understanding The “False Appearance”

The definition of Pseudostrabismus

Imagine looking at a photograph of a building. Depending on the angle, the lines might appear distorted, even though the building itself is perfectly straight. Pseudostrabismus is similar – it's an optical illusion. Your child's eyes are actually aligned correctly, but they appear crossed. This "false appearance" is what makes it different from true strabismus. Think of it as a visual trick caused by certain facial features, not a problem with the eyes themselves.

The difference from True Strabismus

It's essential to understand the difference between pseudo and true strabismus. True strabismus (also called squint) is a condition where the eyes are actually misaligned. One eye might turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). This misalignment prevents the eyes from working together properly. Pseudostrabismus, on the other hand, is just a matter of appearances. The eyes are working together correctly, even if they don't look like they are. This distinction is vital because true strabismus often requires treatment, while pseudostrabismus typically does not.

The Reasons Behind the Illusion

Anatomical Factors:

Several anatomical features can contribute to the illusion of crossed eyes:

  • Wide Nasal Bridge: Infants and young children often have a wide, flat nasal bridge. This can make the eyes appear closer together and create the impression that they are turning inwards.
  • Epicanthic Folds: These are folds of skin at the inner corners of the eyes, covering part of the white of the eye (sclera). This is very common among people of Asian descent. These folds can obscure the inner part of the eye, making it seem like the eyes are crossing. Imagine curtains partially covering a window – you might misjudge the window's size.
  • Hypertelorism: While less common, increased distance between the eyes (hypertelorism) can also contribute to the perception of misaligned eyes, specifically it makes it look as it was exotropic strabismus.

When you Suspect True Strabismus:

While pseudostrabismus is usually harmless, it's crucial to rule out true strabismus. If you notice any of the following signs, it's important to consult an strabismus doctor:

  • Consistent eye turning, even if it's only one eye.
  • Difficulty tracking moving objects.
  • Squinting or tilting the head to see better.
  • Covering one eye to see clearly.
  • Double vision.

There's a simple strabismus test you can perform at home to evaluate if your case is a true strabismus.

Diagnosis, Management, and Reassurance

The Role of an Eye Doctor:

A comprehensive eye exam by an ophthalmologist or optometrist is the best way to determine if your child has pseudostrabismus or true strabismus. They will perform various tests, such as the cover test (covering one eye at a time to observe the other eye's movement) and check how the eyes focus and work together.

Reassurance and Long-Term Outlook:

If your child is diagnosed with pseudostrabismus, you can be reassured that it's typically a cosmetic concern that often improves as their face matures and the nasal bridge narrows. No treatment is usually needed for pseudostrabismus itself. It's simply a matter of waiting for those adorable baby features to change!

When to Consider Intervention (Rare Cases):

In very rare cases, if a child with pseudostrabismus also develops a refractive error (like nearsightedness) or if true strabismus develops later, then treatment like glasses or vision therapy might be considered. But this is the exception, not the rule.

There are modern solutions to real strabismus

If it turns out that you or your child suffer from true strabismus, there are a series of treatment that can help solving this issue at different ages.

The treatment option will vary depending on the causes of strabismus and the age of the patient. In general, the treatment involves glasses, strabismus eye patch, and visual therapy.

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Vision therapy represents a "new" hope even for adult strabismus and lazy eye.

For the people with true strabismus, it's very common especially for strabismic adults to suffer from binocular vision dysfunction, and that's why vision therapy it's the real solution to the underlaying problem of not having stereopsis. At AvalonWeb.com.au, we are proud to offer Equal-Eyes, our innovative VR vision therapy for adult lazy eye and binocular vision dysfunctions. This program, created and developed by an electronic, electrical, and software engineer, Mr. Mark Boyce, a person who understands first-hand what it is to have these 2 conditions, provides an engaging platform for patients to improve their visual skills and overcome challenges associated with strabismus.

Conclusion

Understanding the difference between pseudo strabismus and true strabismus is crucial for parents and individuals alike. Pseudo strabismus is often a harmless, visual trick caused by certain facial features, while true strabismus involves actual eye misalignment that may require treatment. By recognizing the signs and seeking appropriate medical advice, you can ensure the best care for your child. Remember, most cases of pseudo strabismus resolve naturally as the child grows. For those with true strabismus, modern treatments like vision therapy offer hope and solutions. Stay informed and proactive to support healthy vision development.

FAQs

What causes pseudo strabismus?

There are a series of physical traits that can cause the look of pseudo strabismus including: Wide Nasal Bridge, Epicanthic Folds, and Hypertelorism.

How to differentiate between strabismus and pseudostrabismus?

By following a simple at home strabismus test you can evaluate if your case is a true strabismus.

How to correct pseudostrabismus?

In general Pseudostrabismus does not require any correction treatment, as it disappears as a child grows and their facial features mature. In cases of Wide Nasal Bridge and Epicanthic Folds that cause pseudostrabismus as an adult, the person can consider aesthetic surgery.

What age does pseudostrabismus go away?

In the infants, the pseudo strabismus usually disappears around the age of 3 years old.

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