The cover–uncover test will demonstrate a tropia; when the fixing eye is covered, the other eye will display an abduction movement.
Both the cover–uncover test and the alternate cover test, even with excellent fixation on an accommodative target, will not demonstrate any deviation.
This child is unlikely to demonstrate inferior oblique overaction (IOOA) or dissociated vertical deviation (DVD). These findings generally develop after initial presentation of esotropia.
With time, this condition will spontaneously improve.
Answer: A. The cover–uncover test will demonstrate a tropia; when the fixing eye is covered, the other eye will display an abduction movement.
Explanation: This child has pseudo-strabismus. A broad nasal bridge with epicanthal folds can sometimes obscure the nasal sclera and simulate esotropia. As the child grows, the nasal bridge will not be as prominent and the folds may disappear. Cover testing will reveal orthophoria. DVD and IOOA develop in association with congenital esotropia in up to 60% to 70% of cases.