Background: About 2% of the patients with an early-onset esotropia reveal a severe head tilt, of which about 80% tilt their head towards the side of the dominant eye. This is an abnormal posture without a profit for the patient, needing a torsional shift operation. A minority (20%) tilt to the side of the non-dominant eye, while presenting with a severe and unilaterally pronounced DVD. Once the DVD is really bilateral in terms of clinical aspects, patients have a tendency to give in preferring a consistent upgaze position.
Patients: Within 73 patients operated here for DVD (1995-1998) 19 showed the first and 10 the second here described head position.
Results: One of the first group (tilt) failed, while all the others had improvements of their postures, always to the degree of a socially acceptable appearance.
Conclusion: A marked Faden operation on the superior rectus muscle of the elevating eye, occasionally bilaterally (in 2 cases of the upgaze-group) is a very rewarding procedure, much more than the "torsional Kestenbaum" in cases who tilt to the dominant side.