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Background/Aims: Cackground/Aims: This article is a narrative analysis of literature relating to ocular-motor imbalance and the potential postural consequences. It aims to highlight the importance of sensory integration between the visual and vestibular systems and proprioception. The consequences of extra-ocular muscle imbalance are discussed in terms of the disruption to this sensory integration. The symptoms that this may give rise to include spinal pain, postural instability and potential increased risk of falls. This paper therefore encourages a wider multidisciplinary awareness in managing patients with such symptoms. [ABSTRACT FROM AUTHOR]

The cause of the anomalous head posture (AHP) has been mainly assigned to ocular, orthopedic, and neurologic causes. The AHP can take the form of head tilt, face turn, chin up, chin down, or combined, depending on the specific etiology. However, there are many variations, and the type of the head posture cannot reliably predict the underlying cause. Ocular AHP is usually an attempt to improve visual acuity or binocularity. Since the etiology is not always obvious, we stress that these patients must be carefully evaluated by ophthalmologists. Our effort here is to offer the neurologist a thorough insight in the specific head posture pattern primarily related to visual disorders. [ABSTRACT FROM AUTHOR]

Purpose: Periodic alternating nystagmus (PAN) is a spontaneous horizontal nystagmus observed in disorders of the central nervous system. Patients with congenital PAN complain of oscillating vision at high rates. Medication is the first-choice treatment for PAN; however, clinicians still seek better therapy. The aim of this study was to evaluate outcomes of recession of four horizontal rectus muscle (R-FHR) in patients with congenital PAN. Patients and methods: This study reports a retrospective case series of ten patients (seven males and three females; mean age 24.4±10.9) with congenital PAN who underwent R-FHR between 2007 and 2012, which was performed by the same surgeon at the Hyogo College of Medicine. Patients were evaluated for complications, recession amount, deviation angle, eye movements including a nystagmus amplitude, and visual acuity during pre- and post-operative periods. Results: Pre-operatively, patients complained of oscillating vision, abnormal head posture, esotropia, and congenital superior oblique palsy. Post-operatively, changes from the previous observations of nystagmus amplitudes and abnormal head posture demonstrated a complete reversal in all patients. In addition, visual acuity determined with a Snellen chart improved in two patients. However, esotropia occurred in three patients who underwent additional strabismus surgery 2 days after R-FHR. R-FHR was particularly effective in eight patients who preoperatively had periodic oscillating vision with a regular pattern of periodic nystagmus. Conclusion: We demonstrated that ten patients with congenital PAN had improved vision following R-FHR, indicating that R-FHR was an effective procedure, especially in patients suffering PAN with periodic oscillating vision. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery. Materials and Methods: A non-comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied. Results: The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right-sided. Mean follow-up period was 17 months (range 7-36). The outcome was determined at the last follow-up. Mean pre-and post-operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively (P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees (P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42-88%) and 85% (11/13. C.I. 56-96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35-88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% - C.I. 6.7-22.2). Conclusions: Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one-third required an additional procedure, which led to total normalization of the head position. [ABSTRACT FROM AUTHOR]

Anterior plagiocephaly due to unicoronal craniosynostosis is commonly associated with an ipsilateral hypertropia and a contralateral head tilt. The ipsilateral superior oblique weakness has been attributed to the shortening of the orbital roof with retroplacement of the trochlea, and to heterotopic positioning of the vertical rectus muscles within the orbit. These anatomical aberrations may alter ocular rotations to mimic a true congenital superior oblique palsy. This paper describes two siblings with synostotic plagiocephaly and simulated superior oblique palsy with ocular torticollis successfully managed by strabismus surgery. Synostotic plagiocephaly should be included in the differential diagnosis of familial congenital superior oblique palsy. [ABSTRACT FROM AUTHOR]

Aims: To evaluate, by means of electronic baropodometry (EB), the postural findings in patients affected by ocular torticollis. Methods: Posturographic analysis (length of the sway path, sway area, and mean velocity) was made in 54 patients with IV palsy, Duane Syndrome, or rectus superior palsy (group A) and compared with a control group of 45 healthy subjects (group B). The test was performed with both eyes open, then both closed, then with the affected eye open, and finally with the healthy eye open. Results: With both eyes open or closed, the length of the sway path, the sway area, and mean velocity were significantly increased in group A compared with group B ( P<0.0001). When the open eye was the one with the muscular paresis, the length of the sway path was significantly increased as compared with the healthy eye ( P<0.0001), and the sway area was increased too ( P<0.029). No statistical differences were observed mean velocity according to which eye was open ( P==NS). Conclusions: EB is a useful instrument for studying secondary postural anomalies in patients affected by OT. [ABSTRACT FROM AUTHOR]

Bei horizontalem Nystagmus wird der horizontale konkordante Torticollis ocularis durch das dominante Auge induziert. Dabei ist zwischen der Adduktion oder der Abduktion des dominanten Auges zu unterscheiden und die jeweilige Heterotropie des anderen Auges zu berücksichtigen. Da für Bewegungen der früher angenommene Reflexbogen seine Gültigkeit verloren hat, kommt der dualistischen Hypothese von Eccles über die Wechselwirkung von Bewußtsein und Verbindungshirn (liaison brain) für die nähere Analyse der Blickmotorik eine besondere Bedeutung zu. Horizontal concordant ocular torticollis in horizontal nystagmus is induced by the dominant eye. Here the adduction and abduction of the dominant eye must be differentiated, and the heterotropia of the fellow eye must always be taken into consideration. In as much as the earlier thesis of a reflex arcarde has lost its validity for eye movements. Eccles' dualistic hypothesis of interaction between consciousness and the liaison brain now takes on particular significance in detailed analysis of the mechanism of occular movements. [ABSTRACT FROM AUTHOR]