Head tilt–dependent esotropia associated with trisomy 21☆
Presented at: American Academy of Ophthalmology Annual Meeting, October, 2002; Orlando.
Received 24 February 2003; accepted 22 July 2003.
Abstract
Objective
To describe a series of patients who used a head tilt to control esotropia.
Design
Retrospective noncomparative case series.
Participants
Seven children with esotropia that decreased with their compensatory abnormal head tilt. Six of the patients had trisomy 21. The patients had no other identifiable etiology for their head tilt, including no oblique muscle dysfunction, nystagmus that changed with head tilt, or uncorrected refractive error.
Intervention
Six patients underwent horizontal extraocular muscle surgery. Preoperative evaluation in 4 patients included assessment of the change in head position with either monocular occlusion or prisms.
Main outcome measures
Ocular alignment in primary position and improvement in abnormal head tilt after surgery.
Results
In the 4 patients who underwent preoperative testing, the abnormal head tilt resolved with either monocular occlusion or prisms. The head tilt and esotropia were eliminated or improved in all patients who underwent strabismus surgery.
Conclusions
Abnormal head tilt may be used as a compensatory maneuver to improve purely horizontal strabismus. This finding appears to be associated with trisomy 21. Horizontal extraocular muscle surgery may improve the head tilt in such patients.
1Departments of Ophthalmology and Visual Sciences and Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
2Children's Eye Center, Wilkes-Barre, Pennsylvania, USA
3Department of Ophthalmology, Long Island Jewish Medical Center, Great Neck, New York, USA
4Department of Ophthalmology and Visual Sciences, University of Wisconsin Hospital, Madison, Wisconsin, USA
5Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA
Correspondence to Gregg T. Lueder, MD, St. Louis Children's Hospital (Room 2s89), Washington University School of Medicine, One Children's Place, St. Louis, MO 63110, USA.
ABSTRACT