Do I need an eye exam for children with “head tilted vision”? Yes, very much so. Many patients are misdiagnosed as having a “bony strabismus” and undergo orthopedic surgery, which not only does not improve the strabismus in the slightest, but also leaves significant scarring on the neck, causing lifelong pain to the child. In fact, patients with congenital paralytic strabismus often present with a “crooked head” and should be operated as soon as the disease is diagnosed through ophthalmic examination. With strabismus surgery, not only is the head tilt corrected, but the child’s binocular vision is also preserved. In addition, congenital nystagmus, unequal vision in both eyes, unequal hearing in both ears, or the presence of an impingement in one eye may cause a child to see askew.