What Are Setting Sun Eyes? (Setting Sun Sign)

Setting sun eyes, also called “sunset eyes” or “setting sun sign,” refers to a phenomenon in infants and young children in which the eyes are focused downward, and the upward gaze is inhibited. 

There is a visible white space between the top portion of the sclera (white part of the eye) and the iris (colored part of the eye) in babies with setting sun eyes. Sometimes, the lower eyelid may also cover a portion of the pupil due to the eyes gazing downward.

The condition is often a sign of a neurological problem and should be evaluated as soon as possible.

What causes setting sun eyes?

Setting sun eyes are most often associated with neurological conditions that cause an increase in intracranial pressure and affect the part of the brain that controls eye movement. One such condition is hydrocephalus, a condition in which there is excessive fluid in the brain. 

Babies who have hydrocephalus may also experience Parinaud syndrome, a condition that can restrict upward eye movement. Hydrocephalus can sometimes lead to Parinaud syndrome, and setting sun eyes can be present with both conditions.

In rare cases, setting sun eyes can also appear without any underlying health concerns. This is known as the “benign setting sun” phenomenon. Doctors believe the benign variety may be caused by underdeveloped ocular reflexes. Changes in light levels can trigger the downward gaze of a child who experiences benign setting sun eyes.

Benign setting sun eyes may resolve on their own by the time a child reaches 6 months of age. Children with sunset eyes due to hydrocephalus need brain surgery to relieve the pressure created  in order for the eye problem to go away.

What are the signs of setting sun eyes?

The most prominent sign of setting sun eyes is its outward appearance. A child with setting sun eyes presents with a fixed downward gaze and an inability to look upwards. A large portion of the sclera (the white of the eye) is visible between the upper eyelid and the iris. The lower eyelid may also cover a portion of the pupil.

If a baby’s setting sun eyes are the result of infantile hydrocephalus, they may have other clinical signs that point to the underlying condition. Some of these symptoms may include:

Keep an eye out for these symptoms and be careful to observe whether your child’s downward gaze is constant or if it is triggered by changes in light levels. If it’s persistent, there’s a greater chance that it is associated with hydrocephalus.

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