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Head tilt-dependent esotropia associated with trisomy 21
Gregg T Lueder1, Brian Arthur, David Garibaldi
1Department 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
Ophthalmology
|March 17, 2004
Summary
Children with esotropia sometimes use an abnormal head tilt to improve their vision. Horizontal muscle surgery can correct both the head tilt and the eye misalignment, especially in patients with trisomy 21.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Management
Background:
- Esotropia, a form of strabismus, can be associated with compensatory head postures.
- Abnormal head tilt is a recognized phenomenon in certain ophthalmic conditions.
Observation:
- A series of seven children with esotropia were observed to have a compensatory abnormal head tilt.
- Six of these patients had trisomy 21.
- The head tilt was not attributable to other common causes like oblique muscle dysfunction or nystagmus.
Findings:
- The abnormal head tilt in these patients was found to improve or resolve with the use of monocular occlusion or prisms.
- All patients who underwent horizontal extraocular muscle surgery experienced improvement in their esotropia and head tilt.
Implications:
- Abnormal head tilt can serve as a compensatory mechanism for horizontal strabismus.
- Horizontal muscle surgery may be an effective treatment for improving head posture in patients with esotropia and associated head tilt.
- The association with trisomy 21 suggests a potential link between genetic factors and the development of this compensatory behavior.