Pseudostrabismus vs strabismus

Patients with epicanthal folds can sometimes appear to have esotropia (convergent strabismus) but have normal eye alignment. Their corneal light reflex and cover tests are normal. In addition to epicanthal folds, wide nasal bridge and narrow-set eyes can also give the illusion of esotropia as less sclera is visible in the nasal aspect of both eyes.

Pseudostrabismus can easily distinguished form strabismus by looking at the patient's corneal light reflex. The patient in the picture below has true strabismus as evident by presence of corneal light reflex in different parts of the cornea.

(image modified from Wikipedia:

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