Sunset eye is a typical feature of?

HPSSC - 2015

Child Health Nursing (Pediatrics)

Easy

Appeared in: HPSSC - 2015

Explanation

The 'sunset eye' or 'setting-sun sign' is a classic feature of hydrocephalus in infants.
It is caused by increased intracranial pressure (ICP) from the accumulation of cerebrospinal fluid (CSF).
The pressure from the dilated third ventricle and suprapineal recess on the midbrain tectum (quadrigeminal plate) leads to paralysis of upward gaze, causing the eyes to deviate downwards.
This makes the sclera visible above the iris, resembling a setting sun, as clearly shown in the provided image.

Option A: Meningitis primarily presents with fever, neck stiffness (nuchal rigidity), and photophobia. While it can lead to hydrocephalus as a complication, the sunset sign is a feature of the resulting hydrocephalus, not meningitis itself.
Option B: Congenital heart disease presents with signs of poor circulation and oxygenation, such as cyanosis (bluish skin), heart murmurs, poor feeding, and rapid breathing. It does not cause the sunset eye sign.
Option D: Encephalitis is inflammation of the brain tissue, typically causing fever, seizures, and altered mental status. While it can cause raised ICP, the sunset sign is not a characteristic or common feature.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of hydrocephalus in infants as background academic context rather than a clinical decision trigger.
Early recognition of the sunset sign by a nurse is a critical finding that requires immediate reporting to the physician for further investigation (e.g., cranial ultrasound or MRI).
This sign is a key component of the neurological assessment for infants at risk for or diagnosed with hydrocephalus.
What if? If the sunset sign appears in an infant who has already had a ventriculoperitoneal (VP) shunt placed, it is a critical indicator of shunt malfunction or blockage, requiring urgent neurosurgical evaluation.

How to Approach the Question

First, analyze the image provided. Observe the infant's eyes and note the downward deviation and the visible sclera above the iris.
Identify this specific clinical sign as the 'sunset eye' or 'setting-sun sign'.
Recall or deduce that this sign is pathognomonic for increased intracranial pressure in infants.
Evaluate the given options to determine which condition is most classically associated with increased intracranial pressure and this specific sign in infancy.
Hydrocephalus is the direct accumulation of CSF, leading to ventricular enlargement and increased pressure, making it the most direct and common cause.
Rule out the other options: Meningitis, congenital heart disease, and encephalitis have different primary clinical presentations.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1385-1387

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 589-591