Torsional Kestenbaum in congenital nystagmus with torticollis

Surgery in idiopathic congenital nystagmus to correct an abnormal head posture is based on the shifting of neutral point. Torsional Kestenbaum has been done in cases of congenital nystagmus with torticollis, without definite localisation of null point and sustained improvement of head posture subsequent to surgery has been attributed to presumed shift of the null point. We present a 6 year-old boy with congenital horizontal nystagmus with marked head tilt towards the left shoulder. Electronystagmography showed dampening of nystagmus on left tilt. Recession/advancement of all four oblique muscles was done to shift the null point and nystagmus dampened in the primary position eliminating the head tilt. This report emphasises the significance of electronystagmography in critical decision of horizontal/torsional Kestenbaum and documentation of innervational changes following surgery and subsequent followup.