為一位母親看產後傷口，與她閒話家常時她提到擔心小寶寶有鬥雞眼，我雖然知道大部分的時候 亞洲小寶寶「看起來」的鬥雞眼是假性的，我還是請他給小兒科醫師評估過確定不需要轉診眼科，才讓他比較放心 。為此我特別詢問了小兒科與眼科醫師的想法，在此彙整出幾點給大家參考。
>亞裔小朋友的眼瞼內折在靠近鼻子的地方比較寬，造成靠近鼻子部分的眼白被遮蔽住，因此會產生「看起來像鬥雞眼」的假性內斜視。
>假性內斜視的小朋友，眼睛位置是正常的，長大之後也會因為臉型的變化，看起來的鬥雞眼會越來越不明顯。
>利用照相閃光燈，或固定光源，可以比用肉眼更精確的評估眼睛位置。因為角膜上的反射光應處在相同位置，(見圖）這個簡單的檢查叫做Hirschberg Test，是一位姓 Hirshberg 的醫生發明的。
>真正的嬰兒型內斜視其實不常見，歐美的小朋友發生率約為百分之一，而亞洲的小朋友發生率約為千分之一。發生的原因不明，但家族病史，早產兒或腦病變，都有可能增加發生的機率。
>嬰兒型內斜視不僅可能造成弱視，立體視也會受影響。一般建議在2 歲前開刀有比較好的機會保護立體視覺，而弱視必須依靠遮蔽治療。
>極少數的真正內斜視有可能是因為更嚴重的眼睛甚至中樞神經問題，尤其是眼睛轉動有問題時，所以小兒科與眼科的評估很重要。
註）
上圖：假性內斜視-- 角膜光線反射點均在9點鐘方向
下圖 ：內斜視-- 角膜光線反射點:右眼約在中點左眼約在3點鐘方向 （取自網路 http://eyerounds.org/cases/124-Infantile-Esotropia.htm）
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I spoke with an anxious mother about her concern of her newborn’s eyes turning in. Although I know that most apparent “eye turns” in Asian babies turn out to be false alarms I still referred her baby to a paediatrician for evaluation. I spoke to a paediatrician and an ophthalmologist since then and gathered a few points which are summarised below:
>Asian babies have wider “epicanthal fold” -- the excess skin fold close to the nose. This skin fold occludes the white part of the eye (sclera) more on the inner corner than the outer corner of the eye thus creating an illusion that the eye turns inwards. This is what we call pseudo-esotropia if the eyes are found to be in the centre position.
>Kids with “pseudo-esotropia” tend to look less “esotropic” when they grow up because your facial structure change a lot during the first 6 years of growth.
>There is a simple test called Hirshberg Test used by doctors to assess alignment of the eyes using a single light source or the flash-light of a camera to create corresponding reflections on the cornea of both eyes. See photos: above - light reflections correspond at 9 o'clock position, below - light reflections do not correspond, one in the centre, the other off centre. image from below is taken from (http://eyerounds.org/cases/124-Infantile-Esotropia.htm)
>A true “infantile esotropia” is rare, occurs in the order of 1 in 1000 for Asian babies (1 in 100 for Caucaisans) for unclear reasons. However, family history, prematurity and some congenital diseases can increase your risk of esotropia.
>Infantile esotropia can cause amblyopia (“lazy eyes”) and affect stereopic vision. Many experts agree that operations before the age of 2 is acceptable to prevent worsening of stereopic vision. Whereas amblyopia requires occlusion therapy to improve vision (not surgery).
>Some rare causes of true esotropia in infants include serious eye and central nervous system disorders. So evaluation by paediatricians and ophthalmologists is important.
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