Surgery to reduce chin-up abnormal head posture with nystagmus
Reviewed by Fiona Rowe

The authors report the surgical results of six patients with chin up abnormal head posture (AHP) in infantile nystagmus syndrome (INS) where maximal inferior rectus weakening (recession) was undertaken along with superior rectus resection in four of the cases. This was a retrospective case review study. Severe AHP was recorded in five patients; all six patients had null zone in downgaze. Mean age at surgery was 79 ±24 months. Four were male. Mean follow-up was 39 ±49 months. Postoperatively, four patients had no AHP and two had a mild AHP. Recession-resection of the vertical rectus muscles for chin-up vertical abnormal head posture associated with infantile nystagmus syndrome. Mild postoperative restrictions were recorded in three patients. Visual acuities remained stable. Two patients needed (successful) reoperation for strabismus. The authors caution against too large resections which can cause restricted depression in abduction.

Recession-resection of the vertical rectus muscles for chin-up vertical abnormal head position associated with infantile nystagmus syndrome.
Law JJ, Zheng Y, Donahue SP.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2022;59(6):410-5.