Akbari Mohammad Reza, Khorrami-Nejad Masoud, Shakor Yasr Adil, Dehghanian Nasrabadi Farzaneh, Kangari Haleh, Dalvand Hamid
Translational research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran.
School of Rehabilitation, Tehran University of Medical Sciences, Tehran.
J Binocul Vis Ocul Motil. 2024 Jan-Mar;74(1):9-16. Epub 2023 Nov 20.
To determine the frequency and manifestations of different ocular causes of abnormal head posture (AHP).
This prospective, consecutive case series study was performed on 149 patients with ocular AHP at Farabi hospital, Iran, from February 2020 to June 2021. All patients underwent routine ophthalmic examinations. The manifestation of AHP was determined by direct observation from three viewing angles, while the patient read the smallest line on the vision chart that they could see. In front, above, and lateral gazes, observations were performed to find head tilt, head turn, and chin abnormal position, respectively. A picture with habitual AHP was taken from all patients. The amount of head tilt was measured by calculating the angle between the line that connects the lips center to the center of the eyebrows and the vertical line using the Corel Draw X7 computer software.
The mean age of 149 patients with ocular AHP [101 (67.8%) males and 48 (32.2%) females] was 16.2 ± 12.2 (range, 2-57) years. The most common ocular sources of AHP were found to be superior oblique palsy (SOP) in 66 (44.3%) patients, 54 (36.2%) cases with Duane's retraction syndrome (DRS), and 12 (8.1%) patients with nystagmus. Other frequent causes of ocular AHP were dissociated vertical deviation (DVD) in 5 (3.4%), A and V pattern strabismus in 3 (2.0%), and 2 cases (1.3%) in each of Brown syndrome, inferior rectus (IR) palsy, and congenital fibrosis of the extraocular muscles (CFEOM). The most common manifestations of AHP in all cases were "pure head turn" (48.3%), followed by "pure head tilt" (24.8%), "simultaneous head tilt and head turn" (20.8%), and "chin up" (6.0%). The mean head tilt among all patients with head tilt was 10.4° ± 8.9° (range, 5.0°-31.7°).
The most frequent ocular sources of AHP were SOP, DRS, and nystagmus, followed by DVD, A and V pattern strabismus, IR palsy, CFEOM, and Brown syndrome. In addition, pure head turn and pure head tilt were the most common manifestations of ocular AHP but were not always seen in the same direction or combination as previously reported with these etiologies.
确定导致异常头位（AHP）的不同眼部病因的频率和表现。
本前瞻性、连续性病例系列研究于2020年2月至2021年6月在伊朗法拉比医院对149例患有眼部AHP的患者进行。所有患者均接受了常规眼科检查。通过从三个视角直接观察来确定AHP的表现，同时让患者阅读他们能看到的视力表上最小的一行。在正前方、上方和侧面注视时，分别进行观察以发现头部倾斜、头部转动和下巴异常位置。为所有患者拍摄了习惯性AHP的照片。使用Corel Draw X7计算机软件通过计算连接嘴唇中心与眉毛中心的线与垂直线之间的角度来测量头部倾斜量。
149例患有眼部AHP的患者（101例（67.8%）男性和48例（32.2%）女性）的平均年龄为16.2±12.2岁（范围为2 - 57岁）。发现导致AHP最常见的眼部病因是66例（44.3%）患者的上斜肌麻痹（SOP）、54例（36.2%）杜安眼球后退综合征（DRS）患者以及12例（8.1%）眼球震颤患者。眼部AHP的其他常见病因包括5例（3.4%）的分离性垂直偏斜（DVD）、3例（2.0%）的A和V型斜视，以及布朗综合征、下直肌（IR）麻痹和眼外肌先天性纤维化（CFEOM）各2例（1.3%）。在所有病例中，AHP最常见的表现是“单纯头部转动”（48.3%），其次是“单纯头部倾斜（24.8%）、“同时头部倾斜和头部转动”（20.8%）以及“下巴上抬”（6.0%）。所有有头部倾斜的患者中头部倾斜的平均角度为10.4°±8.9°（范围为5.0° - 31.7°）。
导致AHP最常见的眼部病因是SOP、DRS和眼球震颤，其次是DVD、A和V型斜视、IR麻痹、CFEOM和布朗综合征。此外，单纯头部转动和单纯头部倾斜是眼部AHP最常见的表现，但并不总是以先前报道的这些病因所对应的相同方向或组合出现。
