Ocular torticollis

compensatory head postures

Abstract

Torticollis and compensatory head postures are terms indifferently applied to describe a deviation of the head relatively to the body. This may be due to orthopaedic defects (of cervical vertebras, muscular contractures) or ocular causes which represent adjustments for compensation of oculomotor imbalances (incomitant strabismus or heterophorias, blockade of nistagmus, fixation by an eye deviated in its orbit, blepharoptosis and others, less frequent). The quantification of a head posture evokes the need of an analysis about conceptual (criteria and referentials) and operational related problems. The differential diagnosis between orthopaedic and ocular causes is reached by the examination of passive movements of the head relatively to the body and by those of the oculomotor balance (cover test, ocular rotations). Since an ocular cause is proved, its correction depends on a specifically directed surgical procedure, basically that of an adequate repositioning of the fixating eye in its orbit and that of neutralization of an angle of strabismus if it is present. Several practical cases are then commented.