Surgical treatment of a patient with congenital nystagmus with compensatory head posture: A case report

Abstract

The correction of compensatory head posture in a congenital nystagmus involves surgical treatment that includes recession and resection of extraocular muscles to move the eccentric null zone to a primary position.
 A 39-year-old patient presented with an impaired visual acuity and nystagmus that was present since childhood. She had a left head turn with permanent neck pain. At the examination, best corrected visual acuity was 0.4 in both eyes with her glasses. Correction in the right eye was -6.50-1.50/180° and in the left eye -5.50-2.50/180°. Measured objective and subjective angles of squint were +4°, fusion from -3° to +29°, with the presence of stereo vision. During the cover test the nystagmus was present and it enhanced while covering the eye. Ocular motility was not limited. Fundus examination revealed myopic changes in both eyes. Prisms were prescribed, which were well tolerated by the patient. Also, no apparent head turn was noticed while wearing the prisms.
 Nine months later, the patient underwent a Kestenbaum procedure. Retroposition of the lateral rectus muscle with resection of the medial rectus muscle in the right eye and retroposition of the medial rectus muscle with resection of the lateral rectus muscle in the left eye were performed. After the procedure nystagmus dampened the most in the minimal left position, the head was in a straight position. Two years after the procedure nystagmus dampened the most in the primary position, the head was in a straight position. Nine years after surgery and refractive correction with contact lenses, the visual acuity was 0.8-0.9p in both eyes.
 The presented case showed that adequate functional and surgical treatment led to a good morphological outcome with improved visual acuity in a patient with congenital nystagmus and a compensatory head posture even in adulthood.