Is it strabismus if a child always likes to watch TV with his head tilted and his eyes squinted?

Is it strabismus if a child always likes to watch TV with his head tilted and his eyes squinted?

In the clinic, parents often ask, my child always likes to watch TV with his head tilted and his eyes squinted. Is there something wrong with his eyes? Is this case of strabismus? In fact, looking at things with one’s head tilted and squinting in the true sense are two different concepts.

There are many types of strabismus

“Strabismus” refers to the incoordination of the two eyes, that is, when one eye is looking at the target, the other eye is deviated.

For example: when the left eye looks forward, the right eye does not look forward at the same time, but looks to the left or right. Looking to the left (inside) is esotropia, which is commonly known as “cross-eyed”; Looking to the right (outside) is exotropia. Or, when looking at something, one of the two eyes is higher and the other is lower, resulting in a vertical squint.

Some strabismus may be accompanied by a compensatory head position, which means that when the head is tilted to look at things, the two eyes can see more harmoniously, the strabismus angle becomes smaller, and the degree of diplopia is reduced, and the patient will like to look with the head tilted. In clinical practice, the most common congenital extraocular muscle palsy, congenital trochlear nerve palsy, can lead to the typical performance of tilting the head to the left or right shoulder to view objects.

In these cases, you should consult a strabismus specialist

What should you do if you find that your child is looking at things with his head tilted? It is recommended that parents observe whether this behavior of their children occurs continuously or occasionally.

If a child is found to have persistent tilted head and vision soon after birth, he should first go to an orthopedic department to rule out torticollis caused by abnormal development of neck skeletal muscles, and then go to an ophthalmologist to evaluate whether there is binocular vision caused by extraocular muscle paralysis. Problems such as double vision (double vision).

Head tilt caused by diplopia is often persistent and can be identified using a simple method. Cover either eye for a period of time and then observe the child. If the head tilt is caused by double vision in both eyes, it will improve significantly after covering one eye and the double vision disappears.

In addition to children, adults may suddenly suffer from factors that lead to incoordination in binocular vision, such as common extraocular muscle paralysis, acute common esotropia, etc., which can also cause persistent head tilt to look at objects.

Depending on the cause, the face may rotate to the left or right, raise or lower the head, tilt the head to the left or right, or a combination of the above three axes. If these situations occur, you should go to an ophthalmology strabismus specialist for treatment and treatment.

 There are other reasons why children tilt their heads to look at things.

Among children who see things with their heads tilted, most of the symptoms are intermittent, such as when they watch TV for a long time.

In addition to poor eye habits, the more common reasons include: children have myopia, hyperopia, astigmatism (refractive error), etc., or a large difference in refractive power between the eyes (anisometropia). Tilting the head may be accompanied by actions such as squinting. In order to see things more clearly, children like to tilt their heads to see.

In addition, children who already wear glasses may have unclear vision or discomfort due to the high or low power of the glasses, deformation or eccentricity of the eye frames, which may lead to tilted heads.

If you are a child with nystagmus, the amplitude of nystagmus in your eyes may be smaller at a specific position and your vision is clearer, so you may tilt your head to this position.

In addition, organic diseases in the eye, such as uneven refractive stromal opacity, macular degeneration, etc., may also cause poor central vision, and patients may tilt their heads to find clearer peripheral vision.

Therefore, if you find that your child is seeing things with his head tilted, it is recommended that parents take their child to an ophthalmology clinic in a regular hospital for a comprehensive assessment of vision, refractive status, eyeball position, etc., and then carry out targeted correction and treatment.

Text/Wang Shubujuan (Peking University Third Hospital)

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