Abstract
About 2% of the patients with an early-onset esotropia reveal a severe head tilt, of which about 80% tilt their head towards the side of the dominant eye. This is an abnormal posture without a profit for the patient, needing a torsional shift operation. A minority (20%) tilt to the side of the non-dominant eye, while presenting with a severe and unilaterally pronounced DVD. Once the DVD is really bilateral in terms of clinical aspects, patients have a tendency to give in preferring a consistent upgaze position. Within 73 patients operated here for DVD (1995-1998) 19 showed the first and 10 the second here described head position. One of the first group (tilt) failed, while all the others had improvements of their postures, always to the degree of a socially acceptable appearance. A marked Faden operation on the superior rectus muscle of the elevating eye, occasionally bilaterally (in 2 cases of the upgaze-group) is a very rewarding procedure, much more than the "torsional Kestenbaum" in cases who tilt to the dominant side.
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