Abnormal head position caused by incorrect prescription for astigmatism: Case report

Abstract

Abnormal head position is a compensatory condition which improves patients' vision. It can be caused by ophthalmological problems such as oculomotor imbalances (strabismus, nystagmus) and high astigmatisms. However, it results in esthetic impairment, orthopedic trouble and facial asymmetries. We describe a case of a girl, JL, 8 years, with abnormal head position tilted to the left since the last glasses were prescribed. The correction used by the patient was: right eye = +2.00 sph ◇ -5.5 cyl 180° and left eye = +2.25 sph ◇ -5.75 cyl 180°. In tilted position, the correct visual acuity was: right eye 6/12 and left eye 6/9. No deviations were noted by the cover test and the remaining ophthalmological examination was completely normal. Retinoscopy under cycloplegia and subjective test showed right eye = +3.50 sph ◇ -6.00 cyl 10° and left eye = +3.50 sph ◇ -6.00 cyl 170°, with visual acuity 6/6 in both eyes. With adequate prescription, the head position was normalized. Wrong cylindrical positions for correction of high astigmatisms may cause abnormal head position. Retinoscopy under cycloplegia and subjective test are essential for precise diagnoses and prescriptions.