Torticollis, Nystagmus, and Incomitant Strabismus

Abstract

Torticollis comes from the Latin word torti, meaning twisted, and collis, meaning neck. Simply speaking, we can consider two types of torticollis: musculoskeletal and ocular. Musculoskeletal torticollis is caused by tight neck muscles (usually the sternocleidomastoid) or a skeletal deformity. With musculoskeletal torticollis, the neck will resist passive flexion with the eyes open or closed, and these patients maintain their head posturing even during sleep. In contrast, ocular torticollis is a compensatory mechanism to achieve optimal vision in patients with nystagmus or incomitant strabismus. A face turn or head tilt is adopted to place the eyes in a position that either reduces nystagmus or improves eye alignment. Ocular torticollis may be horizontal (face turn), vertical (chin up or down), torsional (head tilt right or left), or a combination of the three. The best way to identify the presence of a face turn or chin posturing is by looking at the position of the eyes. A gaze preference indicates a face turn. For example, does the patient in Fig. 6.1 have a face turn?