The authors report long-term follow-up of a series of seven patients with nystagmus and chin up or chin down head posture that underwent vertical extraocular muscle (EOM) surgery. Mean age at surgery was 56 months (19-96 months). All had horizontal nystagmus (infantile nystagmus syndrome). Four had oculocutaneous albinism and one had cone-rod dystrophy. There were five females. Five had chin down head posture of 25-30 degrees. Three had comitant esotropia and two had exotropia. Two had chin up head posture of 15-25 degrees. Five patients had combined rectus and oblique muscle surgery. Six patients showed improved head posture postoperatively persisting for a median follow-up of eight years. Two cases had vertical rectus surgery only. The authors conclude vertical EOM surgery improves abnormal head posture with persistent effect long-term.