Head tilt-dependent esotropia associated with trisomy 21.
OBJECTIVE
To describe a series of patients who used a head tilt to control esotropia.


METHODS
Retrospective noncomparative case series.


METHODS
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.


METHODS
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.


METHODS
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.
Lueder
Gregg T
GT
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA. lueder@vision.wustl.edu
Arthur
Brian
B
Garibaldi
David
D
Kodsi
Sylvia
S
Kushner
Burton
B
Saunders
Richard
R
D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications*; D004948:Esotropia / Q000150:complications* / Q000601:surgery; D005260:Female; D019416:Head Movements; D006801:Humans; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies