Sunset eye sign

An ophthalmologic manifestation of upward gaze paresis in infants or young children, characterized by forced downward deviation of the globes with visible superior scleral rim (“setting sun” appearance), typically indicating increased intracranial pressure.

Causes

• Increased intracranial pressure causes

  • Hydrocephalus

  • Ventriculoperitoneal shunt malfunction

  • Brain tumor

  • Intracranial cyst

  • Intracranial hemorrhage

• Neurological causes

  • Parinaud syndrome (dorsal midbrain syndrome)

• Benign infantile causes

  • Physiologic immaturity of vertical gaze control (usually <6-7 months of age)