Improvement of compensatory head postures after strabismus surgery.

PURPOSE: To determine the incidence and relative frequencies of orientations of compensatory head postures (CHP) and success in surgically treating the CHP seen in patients with pure lateral rectus paresis (group I), superior oblique paresis (group II), Duane syndrome (group III), Brown syndrome (group IV), and congenital motor nystagmus (group V).

METHODS: The authors retrospectively reviewed all patients assessed and treated between 1985 and 1991 with these five conditions. Frequencies and orientations of the CHP were determined in all patients in each group. The success of surgery in eliminating the CHP in the subgroups of patients who underwent surgery to treat the CHP also was determined.

RESULTS: The frequencies of CHP were 29.0% of 93 group I cases, 71.2% of 139 group II cases, 68.1% of 91 group III cases, 17.4% of 35 group IV cases, and all 23 group V cases, for an overall incidence of 56.7% of 381 patients. For patients who underwent surgery to eliminate a CHP, success rates were 85.7% of 21 group I cases, 75.6% of 41 group II cases, 87.2% of 47 group III cases, 100% of 5 group IV cases, and 78.3% of 23 group V patients, for an overall success rate of 82.5% of 137 surgical cases.

CONCLUSION: Because CHP is seen frequently in strabismus and nystagmus disorders, ocular causes must be ruled out in any case of an anomalous head posture. Appropriately planned surgery for CHP caused by incomitant strabismus or eccentric nystagmus null zones has a high rate of success in eliminating CHP.