Erduran Bilgehan, Niyaz Şahin Leyla
Malatya Training and Research Hospital, Clinic of Ophthalmology, Malatya, Türkiye.
Ondokuz Mayıs University Faculty of Medicine, Department of Ophthalmology, Samsun, Türkiye.
Turk J Ophthalmol. 2025 Feb 27;55(1):11-15. doi: 10.4274/tjo.galenos.2024.71163.
To analyze the clinical characteristics of patients with abnormal head posture (AHP) due to ocular causes and investigate the effect of treatment on the change in AHP.
Patients with AHP admitted to the strabismus unit of our clinic between 2011 and 2022 were retrospectively analyzed. The patients' clinical and demographic data and change in AHP after treatment were recorded.
A total of 172 patients, 86 females (50%) and 86 males (50%), with a mean age of 14.1±13.9 years were included in the study. The most common ocular causes of AHP were fourth cranial nerve palsy (50%), Duane retraction syndrome (16.9%), and A-V pattern strabismus (15.1%). Sixth cranial nerve palsy, third cranial nerve palsy, nystagmus blockade syndrome, extraocular muscle fibrosis, Brown syndrome, oculocutaneous albinism, and heavy eye syndrome were diagnosed less frequently. The most common AHP type was head tilted position (52.3%), followed by head turned (40.1%), chin down/up (3.5%), and combined form (4.1%). There was a significant relationship between AHP type and diagnosis (p<0.001). Amblyopia was present in 55 (35.7%) and absent in 99 (64.3%) patients. There was a significant relationship between amblyopia and both diagnosis (p<0.001) and AHP type (p=0.003). Of 172 patients, 100 (58.1%) underwent strabismus surgery, 10 (5.8%) had botulinum toxin injection, and 2 (1.2%) were prescribed prism glasses. Sixty patients (34.9%) were only followed up. Among 94 patients who continued follow-up, AHP was reduced in 77.3% and completely resolved in 16.7% of patients treated surgically, and was reduced in 50% and completely resolved in 25% of those treated with botulinum toxin.
The causes of AHP are varied. Ophthalmological and orthoptic examinations should be performed in patients presenting with AHP, and strabismus surgery or botulinum toxin administration may reduce or completely correct AHP in eligible patients.
分析因眼部原因导致头部姿势异常（AHP）患者的临床特征，并探讨治疗对AHP变化的影响。
对2011年至2022年期间我院斜视科收治的AHP患者进行回顾性分析。记录患者的临床和人口统计学数据以及治疗后AHP的变化。
本研究共纳入172例患者，其中女性86例（50%），男性86例（50%），平均年龄14.1±13.9岁。AHP最常见的眼部原因是第四脑神经麻痹（50%）、杜安眼球后退综合征（16.9%）和A-V型斜视（15.1%）。第六脑神经麻痹、第三脑神经麻痹、眼球震颤阻滞综合征、眼外肌纤维化、布朗综合征、眼皮肤白化病和重症眼综合征的诊断较少。最常见的AHP类型是头部倾斜位（52.3%），其次是头部转动（40.1%）、下巴向下/向上（3.5%）和联合形式（4.1%）。AHP类型与诊断之间存在显著相关性（p<0.001）。55例（35.7%）患者存在弱视，99例（64.3%）患者无弱视。弱视与诊断（p<0.001）和AHP类型（p=0.003）均存在显著相关性。172例患者中，100例（58.1%）接受了斜视手术，10例（5.8%）接受了肉毒杆菌毒素注射，2例（1.2%）佩戴了三棱镜。60例患者（34.9%）仅进行了随访。在94例继续随访的患者中，手术治疗的患者中77.3%的AHP有所减轻，16.7%的患者完全缓解；肉毒杆菌毒素治疗的患者中50%的AHP有所减轻，25%的患者完全缓解。
AHP的病因多种多样。对于出现AHP的患者应进行眼科和视光学检查，斜视手术或肉毒杆菌毒素注射可能会使符合条件的患者的AHP减轻或完全纠正。
