A 6-month-old infant is brought for apparent inward turning of both eyes. Cover testing shows no shift, and the corneal reflexes are centred. There are prominent broad epicanthal folds. The most appropriate next step is:
- A Bilateral medial rectus recession
- B Reassurance, as this is pseudoesotropia that resolves with growth of the nasal bridge ✓
- C Full hypermetropic spectacle correction
- D Occlusion therapy of the dominant eye
Correct answer: B. Reassurance, as this is pseudoesotropia that resolves with growth of the nasal bridge
Explanation
Broad epicanthal folds covering the medial canthus hide the nasal sclera, creating the illusion of esotropia. Centred corneal reflexes and a negative cover test confirm the eyes are straight, so no treatment is needed; the appearance improves as the nasal bridge develops. Surgery, spectacles and occlusion all carry real risks and are reserved for genuine deviations confirmed by objective tests.
Reference: Parsons' Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.