Childhood pseudo-squint

Who is the leaflet for? What is its aim?

This leaflet is for parents / guardians of children diagnosed with a pseudo-squint.

What is a pseudo-squint?

Pseudo-squint (sometimes called pseudo-strabismus) is a common condition where there appears to be a squint (turn of the eye) but careful examination shows there is no squint.

In pseudo-squint, one or both of your child’s eyes may look like they are not in the correct position (in the photo below it appears as if the left eye is turning inwards).

Testing by the eye team can prove if there is a true squint (misalignment of the eyes) or pseudo-squint. The eye team includes the eye doctors and orthoptists who are trained to detect and measure squints.

What causes a pseudo-squint?

The most common cause of this is the shape of the face and eyelids in babies and young children. These are different to adults and continue to change as the child grows.

Children can look like they have a squint because of:

• The shape of the face or if the eyes are close together
• The eyelids being different in size or shape
• The bridge of the nose being broad and flat and there is a fold of skin covering the inner corner of the eye (epicanthic fold). This is common in babies and can cause one eye to be partially covered behind the skin fold particularly when looking to the side. This gives the impression that one eye is turning in.

Does a pseudo-squint need any treatment?

No treatment is required because there isn’t a true squint and the eyes are aligned.

Usually the pseudo-squint appearance is temporary and will improve with time as the child’s face stops growing.

Does my child need regular check-ups?

After careful examination, children with a pseudo-squint can be safely discharged from the eye team’s care. The eye examination includes checking the position of the eyes and the eye movements, whether there is a current need for glasses and that the eyes are healthy.

With very young children, we sometimes need to repeat the examinations after a few months to be sure that there is no true squint. Older children may also need to be seen again, for example when a squint that is only present some of the time is suspected (this is called an intermittent squint) or because there is a family history of squints and / or glasses in childhood.

The eye team will discuss with you whether a follow up check is required and the reasons for this.

Can a true squint develop?

Just because a true squint was not present at the time of examination does not mean that one will never develop. Squints can occur in children up to school age and occasionally later in life. Vision screening is undertaken in most schools for children aged 4-5 years. If your child misses school screening for any reason, you should arrange an appointment for a sight test with an optician.

Following discharge, if there is any change in your child’s eyes or if you are concerned in any way, please contact your GP or optician and we will review your child again.