Pseudo-strabismus is a common condition that needs to be distinguished from eyes turning in. With pseudo-esotropia, the infant usually has a wide nasal bridge and wide, prominent epicanthal folds, giving the appearance of eyes crossing. But, in fact, the eyes are straight. When the child looks to either side, the eye hides behind the eyelid folds or wide bridge and looks like they are crossing.
It is important to document proper eye alignment by using a light shined in both eyes at the same time to show where the reflex lies on the eyes (Hirschberg corneal light reflex test). In straight eyes, the light will hit the same spot in both eyes. Sometimes, however, it can be difficult to convince parents or caregivers that the eyes are truly straight, so the light test is often done while the parents look on.
Follow-up is important in patients diagnosed with pseudo-strabismus, as a small percentage of these patients will develop a true esotropia.