Survey of management strategies for nystagmus patients with vertical or torsional head posture.

Surgery for a horizontal face turn or tilt in patients with congenital nystagmus began in 1953 and has been modified frequently since then. There are few published reports stating the frequency of or surgical guidelines for the treatment of a vertical or torsional head position due to congenital nystagmus and associated null point. To address this issue a questionnaire was sent to all members of the American Association for Pediatric Ophthalmology and Strabismus. Most respondents see one or two cases of vertical head posture yearly and use observation as their primary therapy. When surgery is indicated, a graded bilateral vertical rectus recession or combined vertical rectus recession-resection procedure are usually done. Most respondents see no cases of torsional head posture yearly, and an overwhelming majority observe these patients. No one surgical procedure was advocated by most of the responding surgeons.