Signs, Symptoms & Clinical Features
Sunsetting eyes (setting-sun sign)
Sunsetting eyes are a downward deviation of a baby's eyes, a sign that can occur with raised intracranial pressure in hydrocephalus.
In short: Sunsetting eyes (setting-sun sign)
- The eyes appear to look downward, with white visible above the iris.
- It is a sign of raised intracranial pressure in infants.
- It is also called the setting-sun sign.
- It warrants prompt evaluation.
What it is
Sunsetting eyes (the setting-sun sign) is an appearance in which a baby's eyes deviate downward, so that the white of the eye is visible above the colored iris, resembling a setting sun. It is a recognized sign of raised intracranial pressure in hydrocephalus.
Understanding Sunsetting eyes (setting-sun sign)
The downward deviation reflects pressure affecting the parts of the brain that control upward eye movement (related to the dorsal midbrain). It is a notable sign of raised intracranial pressure in infants with hydrocephalus and is part of the broader picture of pressure-related eye findings (which in older children and adults can include a sixth nerve palsy or Parinaud syndrome). The setting-sun sign warrants prompt evaluation, as it suggests significant raised pressure. It is assessed alongside head circumference, the fontanelle, and other signs.
Why it matters
Understanding sunsetting eyes helps families recognize a distinctive sign of raised intracranial pressure in babies, and know that it warrants prompt evaluation as part of assessing hydrocephalus.
Common questions
What are sunsetting eyes?
A downward deviation of the eyes, with white visible above the iris.
What do they indicate?
Raised intracranial pressure in infants.
Should they be evaluated?
Yes — promptly.
Bottom line
Sunsetting eyes are a downward eye deviation signaling raised intracranial pressure in infants, warranting prompt evaluation.
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