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: http://en.wikipedia.org/wiki/File:Strabismus.jpg)

Foster Kennedy Syndrome

Foster Kennedy Syndrome is one-sided optic atrophy with contralateral optic disc swelling. It is typically due to a frontal lobe tumor (usually an olfactory groove meningioma) which compresses the ipsilateral optic nerve causing its atrophy and also raises the intracranial pressure leading to contralateral papilledema. The patient may present with anosmia and frontal lobe signs alongside the visual symptoms (central scotoma).

In the absence of intracranial mass, the above mentioned findings are named pseudo- Foster Kennedy Syndrome. It is classically due to bilateral sequential optic neuritis/ischemic optic neuropathy

Quiz

What is the diagnosis?

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Ans: Waardenberg syndrome. Note the heterochromia irides, white forelock and hypertelorism. There is sensori-neural hearing loss in this condition.

Argyl Robertson Pupils

Argyl Robertson Pupils

Accomodation Reflex Present