title: The frequency and causes of abnormal head position based on an ophthalmology clinic's findings: is it overlooked?
abstract: OBJECTIVE
  To determine the frequency of abnormal head position (AHP) and identify the underlying causes in patients who presented to an ophthalmology clinic due to any ophthalmologic complaint.
  
  
  METHODS
  The medical records of patients who presented with any ophthalmologic symptoms during a 6-month period were prospectively evaluated. In all, 2,710 patients (1,492 female and 1,218 male) aged 6 months-91 years were included in the study. Each patient underwent complete ophthalmologic evaluation.
  
  
  RESULTS
  Among the 2,710 patients, 30 (1.1%) (7 female and 23 male) with a mean age of 14.62 ± 17.45 years (range 6 months-60 years) had AHP. In total, 24 (80%) of the patients with AHP were aged ≤16 years. The initial complaint in the patients with AHP was ocular misalignment in 18 (60%) patients, AHP in 4 (13.3%), abnormal ocular movements in 4 (13.3%), double vision in 3 (10%), and droopy eyelid in 1 (3.3%). Comitant strabismus, nystagmus, and Duane syndrome were the most common causes of AHP. Other diagnoses included fourth nerve palsy, sixth nerve palsy, Brown syndrome, congenital muscular torticollis, ptosis, and blowout orbital fracture.
  
  
  CONCLUSIONS
  The leading underlying causes of AHP in patients who presented to an ophthalmology clinic were ocular and treatable. Of note, in only a minority of these patients AHP was the initial presenting complaint. Clinicians must be aware that observation of any head position that is not normal should prompt additional investigation, as the underlying pathology can cause treatable morbidity or in rare instances mortality, such as in cases of acute cranial nerve palsy.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara - Turkey.
authors.forename: Kadriye
authors.initials: K
authors.lastname: Erkan Turan
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara - Turkey.
authors.forename: Hande
authors.initials: H
authors.lastname: Taylan Sekeroglu
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara - Turkey.
authors.forename: Irem
authors.initials: I
authors.lastname: Koc
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara - Turkey.
authors.forename: Meltem
authors.initials: M
authors.lastname: Kilic
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara - Turkey.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Sanac
mesh_terms: D020434:Abducens Nerve Diseases / Q000150:complications; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005128:Eye Diseases / Q000150:complications*; D005260:Female; D006257:Head; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009139:Musculoskeletal Abnormalities / Q000209:etiology*; D009759:Nystagmus, Pathologic; D015835:Ocular Motility Disorders / Q000150:complications*; D011187:Posture / Q000502:physiology*; D014103:Torticollis / Q000150:complications; D020432:Trochlear Nerve Diseases / Q000150:complications; D014786:Vision Disorders / Q000150:complications*; D055815:Young Adult