OBJECTIVE Ocular torticollis secondary to congenital superior oblique palsy can be associated with facial asymmetry. The purpose of this study was to determine if other ocular causes of head tilting also carry the same association.
DESIGN The study design was clinical evaluation of patients.
PARTICIPANTS Fifteen patients with marked, moderate, or mild head tilts associated with dissociated vertical deviation (DVD), and 3 patients with nystagmus and a torsional null point. A control group was comprised of 3 patients with congenital superior oblique palsy, 3 with traumatic superior oblique palsy, and two normal patients.
INTERVENTION A masked observer analyzed full-face photographs of the subjects.
MAIN OUTCOME MEASURE The presence of facial asymmetry.
RESULTS Facial asymmetry due to bending in/of the sagittal plane of at least two degrees was found in 3 of 4 patients with a marked head tilt from DVD, in 2 of 5 five patients with a moderate head tilt from DVD, in one of 3 patients with a head tilt due to nystagmus, and in one of 3 patients with a head tilt due to congenital superior oblique palsy. None of the patients with a mild head tilt from DVD, traumatic superior oblique palsy, or the normal controls had clinically noticeable facial asymmetry.
CONCLUSION Facial asymmetry can be associated with abnormal head postures, specifically, large head tilts from DVD or nystagmus.