A doubly paradoxical vertical eye deviation with an a pattern strabismus in plagiocephaly: management and a case report with outcome.

Anterior plagiocephaly is a craniofacial anomaly related to premature uni-lateral synostosis. We present a case of anterior plagiocephaly with vertical strabismus, overaction of the contralateral superior oblique muscle and an A pattern. A detailed ophthalmic examination and radio-imaging were done. The patient underwent strabismus surgery and resolution of the strabismus was obtained. Plagiocephaly has been reported to simulate ipsilateral superior oblique muscle paresis. We report a rare occurrence of contralateral superior oblique muscle overaction in an adult with anterior plagiocephaly.