title: [Abnormal head position caused by incorrect prescription for astigmatism: case report].
abstract: Abnormal head position is a compensatory condition which improves patients' vision. It can be caused by ophthalmological problems such as oculomotor imbalances (strabismus, nystagmus) and high astigmatism. However, it results in esthetic impairment, orthopedic trouble and facial asymmetries. We describe a case of a girl, JL, 8 years, with abnormal head position tilted to the left since the last glasses were prescribed. The correction used by the patient was: right eye = +2.00 sph diopter -5.5 cyl 180 degrees and left eye = +2.25 sph diopter -5.75 cyl 180 degrees. In tilted position, the correct visual acuity was: right eye 6/12 and left eye 6/9. No deviations were noted by the cover test and the remaining ophthalmological examination was completely normal. Retinoscopy under cycloplegia and subjective test showed right eye = +3.50 sph diopter -6.00 cyl 10 degrees; and left eye = +3.50 sph diopter -6.00 cyl 170 degrees, with visual acuity 6/6 in both eyes. With adequate prescription, the head position was normalized. Wrong cylindrical positions for correction of high astigmatism may cause abnormal head position. Retinoscopy under cycloplegia and subjective test are essential for precise diagnoses and prescriptions.
authors.affiliation: Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP.
authors.forename: Flávia Augusta Attié de
authors.initials: FA
authors.lastname: Castro
authors.forename: Maria Lúcia Habib
authors.initials: ML
authors.lastname: Simão
authors.forename: Christine Mae Morello
authors.initials: CM
authors.lastname: Abbud
authors.forename: Rosália Maria Simões Antunes
authors.initials: RM
authors.lastname: Foschini
authors.forename: Harley Edison Amaral
authors.initials: HE
authors.lastname: Bicas
mesh_terms: D001251:Astigmatism / Q000534:rehabilitation*; D002648:Child; D003951:Diagnostic Errors / Q000009:adverse effects; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006257:Head; D019416:Head Movements; D006801:Humans; D007909:Lenses; D011187:Posture; D014792:Visual Acuity