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Head Tilt

Article ID: 13
Last updated: 15 Aug, 2017
Revision: 1
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Question

My 11 month old son was diagnosed with infant glaucoma when he was six months. Since then he has undergone 2 goniotomies in the right eye and one goniomoty in the left eye. His pressures in his right and left eye are 25 and 27, respectively. He is currently on cosopt and xalatan. I have noticed that my son tilts his head everytime he looks at something and I have brought this up to the dr and has no answer for it. The dr said he may need glasses. He had an eye examine and the results were good. Optic nerve damage 0.3 horizontally by 0.7 vertically in both eyes. Is tilting of the head associated with him not seeing properly, I am concerned. Any ideas or guidance would be appreciated!

Answer

The fact that your child has a head tilt after 2 Glaucoma Operations in one Eye and one Operation in the other coupled with the fact that we are not able to examine the child, presents to us a difficult issue......but, here are some of the potential causes of a head tilt that must be looked into and properly diagnosed

  1. That the child has a tight muscle in his neck causing the head tilt......not likely if was not seen earlier in life and not present all or most all of the time
  2. That the child has a weak muscle in one eye and that the head tilt is allowing the child to use both eyes by tilting his head
  3. That the child needs glasses and the head tilt is in part allowing the child to see best in that position
  4. That the child is adopting this head tilt as the best position to see the clearest in countering a condition known as Nystagmus
  5. That the visual function is such that the field of vision is best obtained with the head tilted

These are the conditions that must be looked into and ruled in or out..............It is also VERY IMPORTANT that your child's pressure be monitored closely...25 and 27 are above the normal range .......If you are not getting satisfactory answers, a second opinion should be sought

 

Norman B. Medow, MD, FACS

Director, Pediatric Ophthalmology and Strabismus Montefiore Hospital Medical Center Professor –Ophthalmology and Pediatrics Albert Einstein College of Medicine

Scientific Advisory Board
Pediatric Glaucoma and Cataract Family Association

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