Abnormal head posture is diagnosed when your head is tilted and forms an unusual angle with your body. This can occur due to eye or muscle-related problems. 

Here’s everything you need to know about abnormal head position, its causes, treatment, and more. 

An abnormal head posture occurs when your head is at an angle with the body. The head moves away or tilts from its straight position. It is seen in adults and children. Abnormal head positions include: 

Abnormal head posture commonly occurs due to neck muscle problems, but the condition has eye-related or ocular causes too. Certain eye conditions can cause people to tilt or turn their heads to one side to see properly. It can lead to abnormal head posture.

Abnormal head posture caused by vision problems is called ocular torticollis. According to ophthalmologists, about 5.6% of adults and 3.2% of children have ocular torticollis.

Ocular torticollis can develop at any age, but it typically appears in childhood and may become more prominent with time.

These are several common eye conditions that can cause abnormal head posture: 

1. Misalignment of the eyes or strabismus. Sometimes, a person’s eyes are misaligned. One eye looks at something while the other eye looks elsewhere. This is called a squint, strabismus, or crossed eye. If a person has strabismus, they’ll tilt or move their head to another position to best align their eyes. That helps them get rid of double vision and eye strain.

In adults, misalignment of the eyes can cause double vision. In young children, the brain suppresses the image in the affected eye. If strabismus is left untreated in children, it can lead to amblyopia (lazy eye). 

Abnormal head posture due to strabismus can occur due to the following conditions:

People with strabismus due to fourth nerve palsy have weak superior oblique muscles in the eye. They may not be able to look up or down. To align their vision, they tend to tilt their head away from the affected eye. 

Those with sixth nerve palsy have weakened lateral rectus eye muscles. They may not be able to look sideways, so they turn their face to see properly. Some people may also tilt their head up or down to adjust their gaze depending on the eye problem.

2. Abnormal eye movements or nystagmus. Abnormal or jerky eye movements known as nystagmus can cause ocular torticollis. Nystagmus can cause jerky eye movements (jerk nystagmus) and swinging or jiggling of the eyes (pendular nystagmus). It can affect both eyes and cause them to move sideways, up and down, or in a circular motion.

People with nystagmus tend to turn or tilt their heads because certain head positions slow down or stop eye movements. Turning or tilting their head allows them to prevent jiggling or jerky eye movements. 

3. Ptosis (droopy eyelids). People with ptosis (droopy eyelids) typically raise their chin to see properly. Moving the head upward helps the eyes look beyond the droopy eyelid.

4. Use of glasses. If your eyes can’t focus on an image properly, you may have refractive errors like nearsightedness or farsightedness. You’ll need glasses to fix these errors and see properly. While trying to focus, you may end up turning or tilting your head to see through the better eye. This can lead to abnormal head posture. 

Also, differences in vision between your eyes can lead to ocular torticollis. You may tilt or turn your head in the direction of the affected eye to adjust your vision.

Your doctor will diagnose abnormal head posture by checking your medical history and examining you. To check for ocular torticollis, they’ll conduct a full eye exam and check for possible eye conditions. 

They’ll measure the angle of your head tilt or face turn. They’ll also examine your eye movement and alignment at different head positions to check your vision. The doctor will perform a cover test to diagnose strabismus. They’ll shut one eye to see if you stop tilting your head. This helps identify the affected eye. 

The doctor can identify nystagmus and ptosis by checking your eyes externally. They may also perform some eye tests like a retinoscopy to check for refractive errors.

Sometimes, they may perform a test to check for strabismus and eye muscle problems. They may use prisms and stereoscopic tests to check if you have double vision. They may also use the Bielschowsky three-step test to diagnose muscular palsy, which can cause ocular torticollis.

Ocular torticollis can be treated by correcting the underlying eye problem causing the abnormal head posture. If the abnormal head posture is caused by refractive errors, your doctor will prescribe you proper glasses. If you have an abnormal head position due to misalignment of the eyes, your doctor will recommend glasses or surgery. Ocular torticollis due to nystagmus can also be treated with surgery. 

If you have abnormal head posture due to non-ocular causes, physical therapy or exercise can help relieve the tightness in your neck muscles.

Abnormal head posture can lead to permanently tight neck muscles. It can cause long-term neck pain or headache. In children, an abnormal head position may cause abnormal facial bone development, resulting in facial asymmetry.

Children with ocular torticollis position their heads to improve their sight. It’s best to get an early diagnosis and treatment to help eliminate this abnormal head posture. In the meantime, avoid discouraging the abnormal head position until the underlying eye problem is treated.

American Academy of Ophthalmology: “Ocular Torticollis.”

American Association for Pediatric Ophthalmology & Strabismus: “Abnormal Head Position.” 

Community Eye Health Journal: “How to check eye alignment and movement.”

Oftamlologia: “Understanding ocular torticollis in children.”

Texas Children’s Hospital: “Abnormal Head Posture.”

Turkish Journal of Ophthalmology: “Ocular Causes of Abnormal Head Position: Strabismus Clinic Data.”

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