BACKGROUND: Patients may assume abnormal head postures either to maintain single vision or optimize visual acuity. Change in head position may create a "pin-hole" or "stenopaeic slit" effect. Clinicians often encounter patients with uncorrected astigmatism using abnormal head postures to improve acuity. Abnormal head postures, particularly head turns, associated with uncorrected astigmatism have rarely been reported. This poster reports two cases of pediatric head turns related to uncorrected astigmatism and discusses differential diagnosis.
CASE REPORT(S). Case 1 A 5-year-old Asian girl reported for her first general eye exam. The chief complaint and only concern noted by her mother was that she turned her head sideways in either direction to watch TV. Entering visual acuities were 20/40 OD, OS. Moderate hyperopia and WTR astigmatism was found +3.25–2.50x180 OU. An Rx was given for full time wear. Upon follow-up, the child’s father noted that with spectacles her head turn had resolved.
Case 2 A 4-year-old African American boy reported for his annual exam. He had been purposely overminused by 2.50 diopters to reduce his intermittent exotropia. His mother noted a reduced frequency in the eye turn with spectacles but that he continued to turn his head sideways to watch TV. Aided visual acuities were 20/25 OD, OS. Moderate WTR astigmatism was found: PL–1.25x180 OU. A final Rx incorporated the cylindrical correction, the overminus sphere, and 6 diopters of BI prism for full time wear. After 3 months, his mother noted that his head turn had improved 90% with the new Rx.
CONCLUSIONS. Two documented cases of head turns associated with uncorrected astigmatism were reported by Kushner (1979) and Rubin (1986) with one head turn described as completely resolving with correction of the astigmatism. Although rare, it is important to recognize head turns as a clinical sign of uncorrected astigmatism. Additionally, a clinician should rule out other ocular causes of head turns such as strabismus (including paretic etiology), diplopia avoidance, Duane’s Syndrome, and nystagmus.