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Abnormal Head Positions

What is an abnormal head posture?

An abnormal head posture or position occurs when the eyes are not looking directly at the target of interest. Abnormal head positions can include chin up, chin down, head tilted to the right or left, and face turns to the right or left. The abnormal position of the head could be due to an ocular or a non- ocular problem.

What are some of the ocular causes of an abnormal head position?

Eye misalignment: Sometimes when a person has eye misalignment (strabismus) the amount of eye misalignment varies with different gaze positions. The person will typically place his or her head in a position where the eyes are best aligned. For example, if a superior oblique muscle is weak (fourth nerve palsy) a person will tilt the head away from the affected eye because the eyes are most straight in this position. Similarly a sixth nerve palsy results in a weakened lateral rectus and a face turn away from the affected eye. Sometimes the eyes are straighter in up or down gaze and a person will tilt the head up or down depending on where the eyes are best aligned. Other causes of abnormal head posture include Duane syndrome, orbital wall fractures, and restrictive eye movement associated with thyroid eye disease.

Nystagmus: Some patients with nystagmus (jerky eye movements) will acquire a head turn or tilt if the nystagmus is lessened in a certain gaze. Decreased nystagmus allows for better vision.

Difference in vision between the eyes: sometimes a child will turn the head to place the eye with better vision closer to the target.

Can my child see when the head is in an abnormal position?

Yes, more than likely your child adopts the head posture to try to use his or her eyes together better either by avoiding double vision or by dampening nystagmus.

What are some of the non-ocular causes of an abnormal head position?

Congenital shortening of the neck muscles (sternocleidomastoid) can cause a head tilt. A patch test will confirm this diagnosis. If the head tilt is due to the neck problem, the tilt will remain the same with the patch on. Other non-ocular causes of an abnormal head position include cerebral palsy, bony abnormalities, occipitocervical synostosis and unilateral hearing loss.