ABSTRACTObjectiveWe investigated the characteristics and factors influencing eye emotion recognition in self‐limited epilepsy patients with centrotemporal spikes (SeLECTS) complicated with electrical status epilepticus during sleep (ESES).MethodsWe selected SeLECTS (n= 160) patients treated in the outpatient and inpatient departments of Anhui Children's Hospital from September 2020 to January 2022. According to the video electroencephalogram monitoring slow‐wave index (SWI), SeLECTS patients with SWI < 50% were assigned into the typical SeLECTS group (n= 79), and patients with SWI ≥ 50% were assigned into the ESES group (n= 81). Patients in the two groups were assessed by The Eye Basic Emotion Discrimination Task (EBEDT) and The Eye Complex Emotion Discrimination Task (ECEDT), respectively. Comparisons were made with age‐, sex‐ and education level‐matched healthy control participants. The correlation between the characteristics of emotional discrimination disorder in the eye area and the clinical influencing factors was analyzed in ESES group, andp≤ .050 was the threshold for significance.ResultsRelative to the healthy control group, scores of sadness and fear in the typical SeLECTS group were markedly lower (p= .018,p= .023), while differences in scores of disgust, happiness, surprise, and anger were not significantly different between the groups (p= .072,p= .162,p= .395,p= .380, respectively). Compared with the healthy control group, the ESES group had significantly low scores in recognition of sadness, fear, disgust, and surprise (p= .006,p= .016,p= .043 andp= .038, respectively). However, differences in recognition of happiness and anger between the groups were not significant (p= .665 andp= .272). Univariate logistic analysis showed that the score of eye recognition for sadness in the ESES group was affected by age of onset, SWI, ESES duration and number of seizures. The score of eye recognition for fear was mainly affected by SWI, while the score of eye recognition for disgust was affected by SWI and number of seizures. The surprised eye emotion recognition score was mainly affected by the number of seizures. Variables withp< .1 were considered to be independent variables of multivariable ordered logistic regression. Multivariate logistic analysis showed that sadness emotion recognition was mainly affected by SWI and ESES duration, while disgust was mainly affected by SWI.ConclusionThe typical SeLECTS group showed impaired emotion (sadness and fear) recognition function in the eye area. The ESES group was associated with more intense emotional (sadness, fear, disgust, and surprise) recognition impairment in the eye region. The higher the SWI, the younger the onset age and the longer the duration of ESES, while the more the number of seizures, the more serious the impairment of emotional recognition function in the affected eye area.