[Synergistic divergence--case report]. / Divergenta sinergica--prezentare de caz.

This 12-year old girl was diagnosed with congenital exotropia (XT) on left eye (OS) when she was 16 month-old and she was subjected to five surgical interventions on OS. She is now with face turn to the right. Visual acuity is 1 cc. Anterior segment is normal on right eye (OD) and multiple scars under bulbar conjunctiva are present on OS. Posterior segment is normal on both eyes. Ocular motility: at cover-test XT is present on OS in primary position measuring 60 PD at distance and near (and left hypertropia) which decreases at 40 on levoversion but increases at over 80 PD on dextroversion. Ductions: OS abolished adduction, limitation of depression, OD normal. Versions: in dextroversion OD abduction is associated with OS abduction. Binocular single vision is absent. Surgery has been done on both eyes (large recessions on lateral recti). Postoperatively orthotropia was present in primary position with persisting simultaneous abduction, but the patient and family are very satisfied about the esthetic aspect.

Understanding ocular torticollis in children.

Ocular abnormal head posture (AHP) or torticollis is a frequent sign in pediatric pathology The incidence is 5.6% in ophthalmological practice and 3.19% in pediatric ophthalmological practice. The abnormal head posture is adopted to improve visual acuity maintain binocular single vision, center residual visual field with the body or for cosmetic reasons. Face turn is the most frequent abnormal head posture in pediatric ophthalmology. The more common diseases causing face turn are Duane syndrome, congenital fibrosis of extraocular muscles, nystagmus, refractive errors, visual field defects. The most frequent ocular causes of head tilt in children are congenital nystagmus, superior oblique paresis, dissociated vertical deviation, Brown syndrome, refractive errors. Chin-up or chin-down abnormal head postures are most commonly caused by "A" and "V"-pattern strabismus, palpebral ptosis, nystagmus, refractive errors. Torticollis is not a diagnosis, but it is a sign of an underlying disease. There are ocular diseases which diagnosis is straightforward for general practitioner, pediatricians or pediatric surgeons (horizontal nystagmus, lateral rectus paralysis, ptosis, esotropia), but others less obvious (superior oblique paralysis, Duane syndrome, A and V-pattern strabismus, torsional nystagmus) because of the compensatory head posture, and these last disorders are predisposed to confusion with congenital AHP Interdisciplinary collaboration between ophthalmologist, pediatrician, pediatric surgeon, ENT specialist and neurologist is mandatory in establishing the etiology of AHP Every child with AHP must be examined by an ophthalmologist.