The patient’s eyes are abnormal and are often described as sun-setting eyes.
The photo demonstrates macrocephaly with frontal bossing, bulging fontanelle, and sun-setting eyes. The physical exam in conjunction with difficulty arousing the baby for feedings, increasing fussiness, and vomiting is concerning for hydrocephalus.
Early signs of hydrocephalus include increasing head circumference, macrocephaly, irritability, fussing, somnolence, vomiting, and inability to control head movement or resistance to head movement. One of the earliest signs is the finding of sun-setting eyes which is seen in hydrocephalus in 40% of cases . Sun-setting eyes can actually present in healthy newborns up to 7 months of age and can be pathological if it is persistent. Sun-setting eyes are usually caused by an upward gaze paresis in the case of hydrocephalus.