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 that the eyes are aligned.

Sometimes one or both eyes may look as if they are turning in, especially in photos. Photos taken at an angle can exaggerate this.

The eye team includes Ophthalmologists and Orthoptists who are trained to detect and measure squints.

Testing by the eye team can prove if there is a true squint or a pseudo-squint.

This includes the corneal light-reflex (Hirschberg) test, which shows whether the eyes are aligned. (In the image below it appears as if the left eye is turning inwards when in fact it is straight).

What causes a pseudo-squint?

The most common cause of this is the shape of the face and eyelids in babies and young children.

Children can look like they have a squint because of:

• Facial shape, including eyes that appear close together
• Slight differences in the eyelid size or shape
• A broad, flat nose bridge and skin fold at the inner corner of the eyes (called an epicanthic fold), which is very common in babies. These folds can partly cover the inside corner of one eye, especially when your child looks to the side, making the eye appear to turn in even though it is straight

Does a pseudo-squint need any treatment?

No treatment is needed because the eyes are in alignment. A pseudo-squint does not harm vision and does not require treatment (RCOphth 2023).

Usually, the appearance of the pseudo-squint will improve with time as the child grows

Does my child need regular check-ups?

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.

Many children with a clear diagnosis of pseudo-squint can be safely discharged.

Some children may be offered another check-up, for example:

• If your child is very young and the first assessment could not be completed fully
• If a squint that only appears some of the time (an intermittent squint) is suspected
• If there is a family history of squints or childhood use of glasses

In these cases, further check-ups help to ensure your child’s eyes continue to develop normally

Can a true squint develop?

Yes, a true squint may develop as children grow, even if they previously had a pseudo-squint. Squints can occur in children up to school age and occasionally later in life therefore:

• Vision screening is offered to children in Reception year (age 4–5) across most of the UK (OHID 2024).
• If your child misses school screening, you can book a free NHS sight test with a community optician.

If you ever notice a change in your child’s eyes any other visual concern, please contact your GP or optician. They can refer your child back to the eye team if needed.