Torticollis is an abnormal position of the head that is assumed either due to skeletal or muscular anomalies or in the presence of problems concerning the eye. Torticollis can therefore be characterized by a rotation to the right or to the left, by a so-called elevation of the chin, or rotatory.
In the event that it is related to skeletal or muscular problems, it will be difficult to rotate the head in the opposite direction and this allows us to make a differential diagnosis. We then passively turn the patient's head to the opposite side of that is usually used to evaluate the anomalies. At that point, you may also consider an ocular problem that may be linked to strabismus, nystagmus, a refractive defect, or the presence of ptosis (lower eyelid).
In the case of strabismus, it is easy. The patient may adopt frequent squinting and stiffer necks because the alignment of the eyes is better in some directions or head positions. The compensatory head posture may allow the patient to have binocular vision and be undisturbed by diplopia.
In the case of nystagmus (continuous oscillation of the eyes), there are certain positions in which this eye movement is reduced or stopped altogether (null point) and therefore allows the patient to see more precisely. Then there are some simple refractive defects such as myopia and astigmatism that are strategically corrected by moving the head and adopting a stiffer neck, so they will simply be corrected with a pair of glasses and then in the presence of ptosis (lowered eyelid), it is often characterized by the presence of a stiff neck with chin moving upwards.
In the case of strabismus, to correct torticollis, the therapy is to surgically correct the strabismus and thus succeed in placing the gaze in the primary position and having the eyes straight. The patient will no longer have to adjust to this abnormal head position in order to use the eyes collectively.
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