Erkan Turan Kadriye, Taylan Sekeroglu Hande, Koc Irem, Kilic Meltem, Sanac Ali S
Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara - Turkey.
Eur J Ophthalmol. 2017 Jun 26;27(4):491-494. doi: 10.5301/ejo.5000908. Epub 2016 Dec 2.
To determine the frequency of abnormal head position (AHP) and identify the underlying causes in patients who presented to an ophthalmology clinic due to any ophthalmologic complaint.
The medical records of patients who presented with any ophthalmologic symptoms during a 6-month period were prospectively evaluated. In all, 2,710 patients (1,492 female and 1,218 male) aged 6 months-91 years were included in the study. Each patient underwent complete ophthalmologic evaluation.
Among the 2,710 patients, 30 (1.1%) (7 female and 23 male) with a mean age of 14.62 ± 17.45 years (range 6 months-60 years) had AHP. In total, 24 (80%) of the patients with AHP were aged ≤16 years. The initial complaint in the patients with AHP was ocular misalignment in 18 (60%) patients, AHP in 4 (13.3%), abnormal ocular movements in 4 (13.3%), double vision in 3 (10%), and droopy eyelid in 1 (3.3%). Comitant strabismus, nystagmus, and Duane syndrome were the most common causes of AHP. Other diagnoses included fourth nerve palsy, sixth nerve palsy, Brown syndrome, congenital muscular torticollis, ptosis, and blowout orbital fracture.
The leading underlying causes of AHP in patients who presented to an ophthalmology clinic were ocular and treatable. Of note, in only a minority of these patients AHP was the initial presenting complaint. Clinicians must be aware that observation of any head position that is not normal should prompt additional investigation, as the underlying pathology can cause treatable morbidity or in rare instances mortality, such as in cases of acute cranial nerve palsy.
确定因任何眼科疾病就诊于眼科门诊的患者中异常头位（AHP）的发生率，并找出其潜在病因。
对在6个月期间出现任何眼科症状的患者的病历进行前瞻性评估。该研究共纳入2710例年龄在6个月至91岁之间的患者（1492例女性和1218例男性）。每位患者均接受了全面的眼科评估。
在2710例患者中，30例（1.1%）（7例女性和23例男性）平均年龄为14.62±17.45岁（范围6个月至60岁）存在AHP。AHP患者中共有24例（80%）年龄≤16岁。AHP患者的初始症状为眼位偏斜18例（60%）、AHP 4例（13.3%）、眼球运动异常4例（13.3%）、复视3例（10%）和上睑下垂1例（3.3%）。共同性斜视、眼球震颤和杜安综合征是AHP最常见的病因。其他诊断包括动眼神经麻痹、外展神经麻痹、布朗综合征、先天性肌性斜颈、上睑下垂和爆裂性眼眶骨折。
就诊于眼科门诊的患者中AHP的主要潜在病因是眼部疾病且可治疗。值得注意的是，这些患者中只有少数以AHP为初始症状。临床医生必须意识到，观察到任何异常头位都应促使进行进一步检查，因为潜在病变可能导致可治疗的疾病，或在罕见情况下导致死亡，如急性颅神经麻痹病例。
