Should I go to the hospital for an early checkup if I am looking at things crooked? An eye exam is recommended for children who look at things with a crooked head. Many children with strabismus, especially those with vertical strabismus, do not have an obvious appearance but look at things with a crooked head. This kind of squint caused by strabismus is called ophthalmic squint. It is due to some kind of compensatory changes taken by the affected child in order to maintain a level view of both eyes, which can cause facial asymmetry and abnormal spinal development, affecting the appearance and having a great impact on the child’s psychological development. In clinical practice, many parents blindly perform neck surgery because they are not quite sure that the crooked head is caused by strabismus, resulting in unnecessary pain to the child. If parents find that their child is looking crooked, they can go to surgery. If the cause of myotropia is excluded, it is better to go to ophthalmology to see if it is ophthalmoplegia for early treatment. This is because a long term tilt of the head can have many negative consequences for the child. First, it is the facial asymmetry brought about by the crooked head (squint), which makes one side of the face plump and the other side thin due to gravity. Secondly, it is the effect on the bones of the neck, causing scoliosis of the cervical spine. Third, it may also cause developmental deformities of the mandible. Parents of babies with congenital paralytic strabismus will find that their children look crooked when they are very young. Parents of children with large strabismus are easy to find and take their children to the ophthalmology department, so it is not easy to delay the disease, and some children with smaller strabismus, who mainly look crooked, are easy for parents to take their children to surgery or delay treatment, and some children are even misdiagnosed and have surgery on the sternomastoid muscle, and the children still look crooked after surgery The parents and doctors are alerted to the fact that the result of the ophthalmology consultation often makes the parents and the surgeon say that there is no problem with the neck, what should we do? Most of us parents know that the child’s crooked head is caused by a disease in the neck, so we have to go to surgery to see if there is an anatomical lesion. Surgical squint is usually relieved by massage, acupuncture and other rehabilitative exercises. However, parents may not be aware that a child’s crooked head may be caused by an eye strabismus. We call this ocular squint. Clinically, there are many children whose crooked head is caused by eye abnormalities. After going to surgery, if the surgeon does not find any obvious neck muscle abnormality, these children with crooked head should consider whether it is oculocutaneous squint. Some children with oculocerebral tilt delay treatment and miss the best time for the child to have surgery. Why is there a problem with the eyes and why is the head tilted? Most oculoconiosis is caused by congenital paralysis of the eye muscles. The most common form is paralysis of the superior oblique muscle in one or both eyes. Ocular tilt is a compensatory response by the child to avoid double vision (seeing with 2 non-overlapping shadows) due to impaired movement of the eye muscles in certain directions. When the child’s head adopts a particular position (many times it can exhibit a squint), the diplopia disappears. When the child adopts this head position, it reduces the discomfort caused by strabismus, maintains binocular vision, and protects visual function. When a person’s eyes are not at the same level, that is, when they have vertical strabismus, they often have diplopia. Children with vertical strabismus often adopt a compensatory head position such as tilted head, sideways face, chin lift or chin tuck in order to overcome diplopia, commonly known as squint. This kind of strabismus caused by strabismus is called oculogyric strabismus. It is different from the strabismus caused by sternocleidomastoid lesions, etc., and can only be eliminated by correcting the strabismus. Although children with vertical strabismus may maintain a certain degree of binocular monocularity due to compensatory head position, long-term strabismus can cause asymmetrical facial development and spinal curvature, which affects the health of the child, so the eye position should be corrected as early as possible.