Rotational strabismus clinically manifests as a rotational tilt of one or both eyes around its anterior-posterior axis toward the nasal and temporal sides, which is an abnormally rotating movement of the eyeball. Most cases of rotational strabismus are clinically due to a force imbalance between the internal and external rotator muscles, and are also associated with abnormal function of the trapezius muscle. Rotational strabismus can exist alone or in combination with other types of strabismus. Generally, upward strabismus and downward strabismus coexist with rotational strabismus. Clinical manifestations may include headache, nausea, vomiting, etc. Severe patients may have visual fusion disorders, and gradually develop compensatory head position and abnormal rotational eye movements. Overall, when rotational strabismus occurs, one should go to the hospital for timely consultation and professional treatment to minimize the adverse effects on visual function.