Pseudostrabismus is the perceived ocular deviation without actual squint, often mimicked by epicanthic folds or abnormal interpupillary distances. The angle kappa plays a crucial role, where a positive angle can simulate exotropia while a negative angle can mimic esotropia depending on the foveal positioning. Understanding these conditions is essential for accurate diagnosis and management.

1. By Babli Sharma
B.Optom, M.Optom

2.  Pseudostrabismus is the
clinical impression of
ocular deviation when no
squint is present.
Epicanthic folds may
simulate an esotropia
Abnormal interpupillary
distance, if short may
simulate an esotropia and if
wide an exotropia
Prominent epicanthic folds
Simulating esotropia
Wide interpupillary distance
simulating exotropia

3. Angle kappa is the angle
between the visual and
anatomical (pupillary) axes.
 Normally, the fovea is situated
temporal to the anatomical
centre of the posterior pole.
 Eyes are therefore slightly
abducted to achieve bifoveal
fixation
 Light shown onto the cornea
will therefore cause a reflex just
nasal to the centre of the cornea
in both eyes
 Termed a positive angle kappa.
Normal
Positive, simulating an
exotropia

4.  A large positive angle kappa
(e.g. temporally displaced
macula) may give a
pseudoexotropia
 A negative angle kappa
occurs when the fovea is
situated nasal to the posterior
pole (e.g. high myopia).
 In this situation, the corneal
reflex is situated temporally
to the centre of the cornea
and it may simulate an
esotropia.
Negative, simulating and
esotropia

5. THANK YOU