Amy, a little 3-month-old was on my schedule with the chief complaint was that her eyes crossed

 

Entering the room, Mom, Amy, 19-month-old brother Jax, and a set of grandparents were waiting with an aura of angst and tension. Reviewing Amy’s chart, I had last seen her at her two-month well check, and she was doing remarkably well. I asked Mom what her concerns were. She told me that as Amy was more aware of her environment, looking around and focusing, her eyes seemed to intermittently cross. Amy’s grandmother silently nodded her head in agreement with a worried look on her face.

 

Upon examining Amy, she was very engaging.

 

She tracked well, smiled at me and was very verbal. I handed her the pacifier. She held it and studied it intently, and then her eyes did cross. “See that,” said Grandmother. “That’s what we are talking about!”

 

I explained to them that it is very common for a newborn’s eyes to intermittently cross, especially when focusing on an object.

 

It is part of normal development. Her brain is learning to integrate an image into a focused picture. The muscles that move the eyeball are learning to coordinate an image with the developing brain. I reassured them that Amy was 100% normal. This frequently happens during the first four months of life. It IS a problem should this persist after four months of age. If so, she would need to see a pediatric ophthalmologist.
 

Everyone seemed relieved with this explanation, especially after I brought out a pediatric textbook that corroborated what I had said.

 

Mom went on to explain why she had also brought Jax. After all the family discussions at home about Amy’s eyes, Grandmother had a picture of Jax. It looked like the right eye was turned in. The general consensus among family members was that his eye truly did turn in. This worried them greatly. Looking at the picture, sure enough, it DID look like the right eye turned in.
 

Jax sat in Mom’s lap and had a bright light to play with.

 

Briefly I would shine it in his eyes to confirm what I suspected. As I moved the light up and down, right-to- left, his eyes moved symmetrically. The light landed on the same part of both eyes. While it did look like the right eye deviated inward when the light landed on the pupil of the right eye, it symmetrically landed on the pupil of the left eye. I told mom to watch his eyes as I moved the light around. Pay particular attention to both pupils as a reference point. Sure enough, she agreed that there was perfect symmetry.

 

Jax had pseudo strabismus which is an optical illusion creating the impression that one eye is turned in.

 

It can be caused by a widened bridge of the nose. It can also be caused by epicanthal folds which are folds of skin that cover the inner corner of the upper eyelid. These are normal and are most prevalent in the Asian population. It can occur in over 90% of certain Southeast Asian countries. Epicanthal folds occur in almost half of the Latino population, and less so in the Caucasian population. While these are completely normal, they can also occur in some genetic disorders. Therefore, the physician must be diligent and keep this in mind.
 

Grandmother showed me the picture that concerned her.

 

I had her look at both pupils and see where the flash from the camera landed on both eyes. It was perfectly in the center of both pupils, thus confirming the diagnosis of pseudo strabismus.
 

When we finished the atmosphere in the room was one of relief and happiness. The tension had disappeared.

 

I gave Jax some stickers, and Mom gave a big whew. She walked in with concern and worry and left with two healthy and normal children.