ocular torticollis
Ocular torticollis is an abnormal head posture adopted to overcome an ocular problem. The posture can combine a face turn to the right or left, a head tilt toward either shoulder, and chin elevation or depression.1
In paralytic strabismus, the head posture moves the eyes away from the field of action of the palsied muscle and into the position of least deviation, where binocular single vision can be kept. A left sixth nerve palsy produces a face turn to the left.1 In a right fourth nerve palsy, the head tilts to the left shoulder, because the right eye is already extorted.1 In congenital nystagmus, a face turn centers an eccentric null zone. Visual field defects, restricted eye movement and discomfort in one gaze position can also produce the posture.1
Ocular torticollis must be told apart from congenital torticollis, which arises from malformed cervical vertebrae or fibrosis of the sternocleidomastoid muscle.2 The ocular form rarely begins before 18 months of age, the head straightens easily, and the head straightens when the paretic eye is occluded. No collar, traction device or neck muscle surgery can correct an ocular torticollis.2
More detail
Cuignet first described ocular torticollis in 1873.2 Chin depression keeps the eyes out of the main field of action of the palsied muscle in a fourth nerve palsy, and chin elevation avoids an area of discomfort in thyroid eye disease or a blow-out fracture.1 Congenital torticollis begins in the first 6 months after birth, the sternocleidomastoid feels hard on palpation, and occluding either eye does not change the posture. In ocular torticollis, straightening the head or tilting it to the opposite side commonly brings on diplopia. With paralysis of a vertical rectus muscle, the head may tilt toward either the involved or the uninvolved side.2
Sources (8)
- Eperjesi and Rundström, Practical Binocular Vision Assessment, ch. 8
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 20
- Boricean, I. and Bărar, A. 2011. Understanding ocular torticollis in children. Oftalmologia, 55(1), pp.10-26.
- Guyton, D.L. 2000. Clinical assessment of ocular torsion. American Orthoptic Journal, 50(1), pp.7-16.
- Herman, M.J. 2006. Torticollis in infants and children: common and unusual causes. Instructional Course Lectures, 55, pp.647-653.
- Kushner, B.J. 1979. Ocular causes of abnormal head postures. Ophthalmology, 86(12), pp.2115-2125.
- Mitchell, P.R. 1999. Ocular torticollis. Transactions of the American Ophthalmological Society, 97, pp.697-769.
- Rutstein, R. and Daum, K. 1997. Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
Reviewed October 2026