Ocular torticollis

Abstract

Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Abnormal head position for ocular reasons is usually assumed in order to maintain binocularity and/or to optimize visual acuity. A variety of conditions may be responsible. The sensory organ of position sense, the labyrinth, lies within the inner ear and it relates to eye movement in both a dynamic and static fashion. The Bielschowsky head tilt test is based on the functioning of the otolithic apparatus and is the primary test in evaluating abnormal head position. Treatment is usually surgical, with extent and location dependent upon on the underlying cause. While corrective surgery has usually been done on an elective basis for cosmetic purposes, there is evidence that uncorrected torticollis can cause musculoskeletal problems. This review describes the physiological bases for ocular torticollis and the diagnosis and treatment of its various underlying causes.

The Effect of Graded Recession and Anteriorization on Unilateral Superior Oblique Palsy

“…The inferior oblique muscle is overactive and hypertropia appears in the paralyzed eye. The amount of aggravation of hypertropia can be measured by the amount of head tilt toward the paralyzed eye 1,11,12. Surgical indications of superior oblique palsy include complaints of diplopia, severe vertical strabismus, and facial asymmetry.…”

Nintendo Wii Remote Controllers for Head Posture Measurement: Accuracy, Validity, and Reliability of the Infrared Optical Head Tracker

“…1 The etiologic factors that are responsible for this condition include ocular, orthopedic, and neurologic abnormalities. 2,3 For example, patients with superior oblique palsy predominantly manifest a head tilt, whereas patients with nystagmus or Duane's retraction syndrome manifest a face turn. 2 Several studies showed that children with ocular torticollis may benefit from early diagnosis and treatment.…”

“…Patients experienced improvement in their visual acuity, and permanent musculoskeletal problems such as facial asymmetry were prevented to some degree. 3,4 Accurate measurement of the angle of anomalous head posture is crucial for evaluating disease progression and determining surgical plans in patients with ocular torticollis. Recently, several useful instruments in measuring anomalous head posture have emerged.…”

Residual torticollis in patients after strabismus surgery for congenital superior oblique palsy

“…It is postulated that the older the child is at the time of operation, the more likely it is that secondary changes and muscle contracture can take place. It has been reported that the presence of torticollis leads to shortening and flattening of the hemiface to which the head inclined 20 21. In our series, the cases with delayed operations were due to late presentations.…”