The sunset sign describes a typical change in eye position, where the eyes deviate downwards and the upper part of the eyeball becomes visible from the outside. This looks as though the sun is setting on the horizon.
How does the sunset sign look?
A key feature is that the iris, which is the coloured part of the eye, becomes partly covered by the upper eyelid. At the same time, a white strip of the sclera (the white of the eye) stays visible above the iris. The eye appears to look downwards, while more white is visible at the top than usual. This appearance is especially noticeable in babies and young children, because their eyes tend to look larger overall.
When does this sign appear?
The sunset sign is not a condition in itself, but a noticeable symptom. It can occur, for example, with raised intracranial pressure, meaning too much pressure inside the skull. This sign is sometimes seen in particular in babies and young children, whose skull bones have not yet fully hardened. The sunset sign can also occur with certain brain conditions, such as hydrocephalus (fluid on the brain).
What does this mean for health?
The appearance of this sign is a warning signal that can point to a problem in the brain. In children with a known hydrocephalus, it is considered an important sign that intracranial pressure may have changed. A rise in pressure like this can become dangerous if it is not recognised and treated in time. Alongside the noticeable eye position, other signs of raised intracranial pressure may also appear, such as vomiting, headaches, a tense fontanelle (in babies), or changes in consciousness.
Should you be worried?
The sunset sign itself is a symptom, not a diagnosis. It points to something being wrong inside the head and is often a sign of raised intracranial pressure. This sign should be taken seriously, especially in children who are already being treated for hydrocephalus or other brain conditions. If it is noticed, a medical examination should take place as quickly as possible to find the cause. With timely treatment, worse outcomes can often be prevented.
What treatment options are there?
Treatment always depends on the cause. If the raised intracranial pressure is caused by a disruption to the drainage of cerebrospinal fluid (CSF), a shunt (a drainage device) may be needed. Sometimes it is enough to treat the underlying condition. What matters most is that the cause of the symptom is found and treated directly. Eye position usually returns to normal once intracranial pressure comes down.
When should you seek medical advice?
As soon as the sunset sign is noticed, especially alongside other symptoms such as vomiting, unusual drowsiness, or a tense fontanelle, there should be no delay. A prompt examination with a paediatrician or at a clinic helps to identify and treat the cause quickly. Particular attention is needed in children with known brain conditions.
The sunset sign is therefore a visible warning sign that should be taken seriously. It can point to a change in the brain that requires quick action to avoid lasting harm.
