The principle of Kestenbaum's surgical rotation of the eyes has been found applicable to cases with head tilt to the shoulder. With restriction to the anterior parts of the obliques, which are acting mainly rotatory, the authors were able to release 9 patients out of 25 from their abnormal head posture with their operation. 12 showed definite improvement. However, the pathophysiology and the abolition of the head tilt to the shoulder could not alltogether be explained yet. Latent nystagmus with a resting position is found in only two out of three, a rotatory component only in one out of three patients. The authors believe that the picture of head tilt to the shoulder may rather be located within the classification of congenital strabismus syndrome (Lang) than within a strict causal classification after a certain type of nystagmus.