Many parents find that their children go to the doctor with a tilted head and eventually find out that it is caused by strabismus, a condition commonly associated with vertical paralytic strabismus. The head tilt is because the child’s eyes are not at the same level and there is “double vision”. Is it true that after strabismus surgery, the head tilting phenomenon disappears when the two eyes are positioned correctly? Theoretically, most children’s head tilt is caused by strabismus alone and should be able to improve after surgery. However, during the treatment process, we found that some children still have a crooked head after surgery for the following reasons: 1. The child is young, does not cooperate with the examination, combined with other hidden strabismus problems, and the residual strabismus degree or strabismus changes after surgery. For example, some children’s head tilted after strabismus surgery is only partially improved, probably because of residual strabismus. In this case, regular review is needed and the doctor will decide the next treatment plan based on the amount of residual strabismus. If the residual degree is large, a second surgery is usually needed; if the residual degree is small, you can correct the eye position by wearing a trigeminal lens to solve the residual crooked head problem. 2. Some children have very successful strabismus surgery, with correct eye position and good recovery of visual function in both eyes, but still have a crooked head, and there is no lesion in the neck when looking for a surgeon. This is usually a habitual head tilt, which is common in older children who have developed a habit of tilting their heads for a long time. Generally, you can wear a neck brace to help restore the neck to the right position; or you can try botulinum toxin for neck-related muscle injection to relieve the symptoms of crooked head. 3. There are also some children whose crooked head is caused by recurrence of strabismus. These children recover well in the early post-operative period and then develop a crooked head again after a period of time. The examination reveals a recurrence of strabismus or other types of strabismus, which requires reoperation or other treatment options depending on the situation. Most children who still have a crooked head after surgery will have one of these reasons and are not a failure of surgery. Therefore, regular review after strabismus surgery is essential so that if there is residual head position or residual strabismus, the surgeon can respond in a timely manner, depending on the circumstances.