Oblique Muscle Surgery for Head Tilt Caused by Congenital Motor Nystagmus

Abstract

This article presents the first reported case of the use of a superior oblique tendon expander to correct a head tilt caused by congenital motor nystagmus (CMN).

A 7-year-old boy with CMN presented with a right head tilt to attain his null zone. He had full extraocular movements and normal eye-muscle balance. He underwent a left inferior oblique recession to incycloduct the left eye and a tenotomy of the right superior oblique on the nasal side with insertion of a retinal band to excycloduct the right eye.

After surgery he no longer had a head tilt, but he developed an exotropia and hypertropia that transiently compromised his binocular vision. By eight months after surgery, his hypertropia had decreased and become a phoria; he recovered stereopsis and peripheral fusion.

Although oblique muscle surgery may be effective in eliminating head tilts in such cases, it may create unwanted tropias after surgery that may disrupt binocular vision in a previously orthotropic patient. Alternative approaches may be preferred to treat such patients.

• congenital nystagmus
• nystagmus surgery
• oblique muscles
• torticollis