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Br J Ophthalmol 2004;88:268-272 doi:10.1136/bjo.2003.021055
  • Clinical science
    • Extended reports

Unexplained head tilt following surgical treatment of congenital esotropia: a postural manifestation of dissociated vertical divergence

  1. M C Brodsky1,
  2. R Jenkins2,
  3. P Nucci3
  1. 1University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  2. 2Baylor University School of Medicine, Houston, Texas, USA
  3. 3Department of Ophthalmology, Università di Milano, Milan, Italy
  1. Correspondence to: Dr M C Brodsky Arkansas Children’s Hospital, 800 Marshall, Little Rock, Arkansas 72202, USA; brodskymichaelcuams.edu
  • Accepted 17 June 2003

Abstract

Background: Strabismus surgery for congenital esotropia can be complicated by the development of a postoperative head tilt.

Purpose: To determine the pathophysiology of acquired head tilting following horizontal realignment of the eyes in children with congenital esotropia.

Materials and methods: Retrospective analysis of nine children with congenital esotropia who developed unexplained head tilts following horizontal realignment of the eyes.

Results: Shortly after strabismus surgery, each child developed a head tilt in association with asymmetrical dissociated vertical divergence (DVD). Five children maintained a head tilt toward the side of the fixing eye (group 1), which did not serve to control the DVD. Four children maintained a head tilt toward the side of the hyperdeviating eye, which served to control the DVD (group 2). Children in group 2 had earlier horizontal muscle surgery and developed better stereopsis than those in group 1, suggesting that the higher degree of single binocular vision and stereopsis in these children may have led to a compensatory torticollis to control an asymmetrical DVD.

Conclusions: The onset of an unexpected head tilt after congenital esotropia surgery is usually a postural manifestation of asymmetrical DVD. In this setting, a head tilt toward the side of the fixing eye corresponds with a postural manifestation of the underlying central vestibular imbalance that produces DVD, while a head tilt toward the side of the hyperdeviating eye serves to counteract the hyperdeviation and stabilise binocular vision.

Footnotes

  • Supported in part by a grant from Research to Prevent Blindness lnc.

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