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Setting Sun Sign

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  • First Online:
Encyclopedia of Ophthalmology

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Synonyms

Downward Ocular Deviation; Sunset Eye Sign

Definition

The “setting sun” sign is an ophthalmologic phenomenon where the eyes appear driven downward bilaterally. The inferior border of the pupil is often covered by the lower eyelid, creating the “sunset” appearance. This finding is classically associated with hydrocephalus in infants and children.

Etiology

The pathogenesis of the setting sun sign is believed to be related to aqueductal distention in the dorsal midbrain on the vertical gaze innervation bilaterally. In children with hydrocephalus, up to 40 % of cases will present with this sign. Of these patients, 13 % harbor ventriculoperitoneal shunts that have failed. The sign is also associated with kernicterus and other features of the full Parinaud syndrome (i.e., dorsal midbrain syndrome). Interestingly, the setting sun sign may also transiently appear in healthy infants up to 7 months of age. This benign phenomenon is believed to be caused by immaturity of reflexes...

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Authors and Affiliations

  1. Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Scurlock 450, Houston, TX, 77030, USA

    Sumayya J. Almarzouqi, Michael L. Morgan & Andrew G. Lee

  2. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX, USA

    Andrew G. Lee

  3. Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX, USA

    Andrew G. Lee

  4. Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA

    Daniel Croft & Andrew G. Lee

  5. Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Andrew G. Lee

Authors
  1. Daniel Croft
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  2. Sumayya J. Almarzouqi
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  3. Michael L. Morgan
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  4. Andrew G. Lee
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Corresponding author

Correspondence to Andrew G. Lee .

Editor information

Editors and Affiliations

  1. Dept of Ophthal & Optometry,AKH, Medical University of Wien Dept of Ophthal & Optometry,AKH, Wien, Austria

    Ursula Schmidt-Erfurth

  2. Department of Ophthalmology, Goethe University of Frankfurt am Main Department of Ophthalmology, Frankfurt am Main, Germany

    Thomas Kohnen

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© 2015 Springer-Verlag Berlin Heidelberg (outside the USA)

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Croft, D., Almarzouqi, S.J., Morgan, M.L., Lee, A.G. (2015). Setting Sun Sign. In: Schmidt-Erfurth, U., Kohnen, T. (eds) Encyclopedia of Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35951-4_1226-1

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  • DOI: https://doi.org/10.1007/978-3-642-35951-4_1226-1

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-35951-4

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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