Pseudostrabismus and Strabismus


What Is Strabismus?

Strabismus is a condition in which the eyes point in different directions. Usually one eye is pointed straight ahead and the other is pointed in, out, up, or down. Strabismus can cause poor vision unless it is treated. It also can affect your appearance.

What Is Pseudostrabismus?

Pseudostrabismus is the appearance of strabismus when it is not truly present. Some babies and young children appear to have strabismus, especially esotropia (an eye turning in), when they do not.

Babies often have a wide, flat nose bridge that can make their eyes appear crossed. Also, babies can have folds in the skin of the inner eyelids that cover the inner white part of the eyes, making their eyes look crossed. The illusion of crossed eyes can be even more pronounced when the baby looks to one side.

How can you tell the difference between pseudostrabismus and strabismus?

A quick way to tell whether your baby has pseudostrabismus or strabismus is by looking at a flash photo of your baby. In the photo, the baby’s face and eyes should be aimed directly at the camera. Look to see where the light reflects in the child’s eyes. If it is pseudostrabismus, light will reflect at the same place in both eyes. The easiest place to see this is in the center of the pupil. If the child has actual strabismus, light will reflect in a different place in each eye.

How we Diagnose Pseudostrabismus

Eye doctors (ophthalmologists) use simple tests to tell the difference between strabismus and pseudostrabismus. For example, the doctor may hold a small light in front of a child’s eyes and look to see whether the reflection of this light is properly centered in each eye. In another test, the doctor covers one of the child’s eyes and then the other to see if the eyes shift abnormally when focusing on a near or distant target. While we can diagnose the problem, we currently cannot treat it.

Is surgery ever necessary to correct strabismus?

In most cases, the only effective treatment for a constant eye turn is strabismus surgery. He changes the length or position of the muscles around the eyes to straighten their orientation. Surgery is the most likely treatment that will allow the patient to develop normal visual acuity and have their two eyes function together properly as a team.

At what age does pseudostrabismus begin to resolve?

True strabismus tends to worsen over time. Pseudostrabismus gets better over time. The reason for most cases of pseudostrabismus is that babies often have a broad flat nasal bridge with small folds of eyelid skin at the inner corner of the eyelids. These features make the eyes look crossed when in reality they aren’t. As the baby’s nose grows and the bridge develops this false appearance will go away.

The time frame when this development and growth occurs varies with the child. Usually, the illusion of strabismus goes away by the time the baby starts walking.

How can I improve my child’s confidence if they have strabismus?

Prior to surgery to correct strabismus, the other vision therapies provided by Dr. John Kirk work to develop and improve the communication between the eyes and the brain to enhance the child’s visual comfort and processing. Vision therapy can improve the visual skills necessary for success in school and on the playground. That will improve their confidence during the period while we’re gauging if non-surgical treatments are resolving the child’s strabismus.

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What Should Be Done for a Child with Pseudostrabismus?

No treatment is needed for pseudostrabismus. The appearance of misaligned eyes often improves as a child gets older.

What you should do if your Child has Strabismus

A child with strabismus should be treated promptly by an ophthalmologist. One type of treatment, surgery on abnormal eye muscles, is quite successful if done when the child is young–and the younger, the better. Even if surgery is not needed, other treatments have a better chance of promoting the best vision possible out of both eyes if they begin when the child is young.

If your child is also diagnosed with amblyopia (which sometimes accompanies strabismus), further treatment may be needed.

Dr. Kirk may use one of several treatment options to improve the patient’s eye alignment and coordination. These include:

  • Eyeglasses or contact lenses — This corrects the refractive errors, typically farsightedness, that is causing the straining of the eye muscles.
  • Prism lenses — These special lenses are thicker on one side than the other. The prisms alter the light entering the eye and reduce how much turning the eye must do to view objects. Sometimes these lenses can eliminate the eye turning.
  • Vision therapy — Vision therapy trains the eyes and brain to work together more effectively. These visual activities and exercises can help problems with eye movement, eye focusing, and eye teaming, and they can reinforce the eye-brain connection.
  • Eye muscle surgery — Surgery can physically correct the length or position of the muscles controlling the eyes.

What happens if a child’s pseudostrabismus doesn’t revolve on its own?

This isn’t a condition that requires treatment. As long as the light reflects in the cornea in the same place in the test described above, the child doesn’t have strabismus — he or she has pseudostrabismus.

Can pseudostrabismus appear in adults?

Adults don’t develop pseudostrabismus because their nose bridge is fully developed. But adults can develop true strabismus. The sudden appearance of strabismus in adults, especially when it is accompanied by double vision, can often be linked to circulation or neurological problems. Mini strokes, diabetes, and hypertension can impair the circulation to the muscle or to the nerves that control them.

Adult strabismus can also occur in adults who were born with the condition, but it resolved as they matured. As the person ages, their risk of it returning increases.

Schedule a client consultation

Regardless of your child’s age, have his or her eyes examined by an eye doctor if you suspect strabismus. True strabismus cannot be outgrown. Schedule an appointment with Kirk Eye Center today by calling 970-669-1107 or completing the form on this page. We serve children and adults in Loveland, Windsor, Fort Collins and all of Northern Colorado.

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