Horizontal transposition of the vertical rectus muscles for treatment of ocular torticollis

In most instances, a head tilt to either shoulder is caused by hypertropia or cyclotropia and responds well to conventional surgical strengthening or weakening operations on the cyclovertical muscles. Occasionally, an ocular head tilt occurs in the absence of cyclovertical strabismus, in association with congenital nystagmus or without an apparent cause. We have successfully treated four of five such patients by surgically rotating the eye(s) around the sagittal axis. This was accomplished by horizontal transposition of the vertical rectus muscles. No complications were encountered. We present this method as a viable alternative to other surgical approaches to rotate the eyes around their sagittal axis.