Experts explain: problems with the child’s vertical muscles can cause oculocutaneous squint. XuanXuan four years old, tiger head is very cute, big eyes, very quiet look, very cute, but the most obvious is that no matter what he does, he always love to crooked a little head! To make a long story short, Xuan Xuan was born white and chubby and very attractive, but when he was about 6 months old learning to sit and stand, his neck seemed to have a problem, looking at objects when the little neck in always crooked to the side, not to mention how ugly it is, mom and dad led Xuan Xuan began to see pediatrics, neurology, orthopedics, surgery ….. The company has been in the business for 4 months, but as time goes by the child’s head tilting phenomenon is becoming more and more obvious. Xuan Xuan’s parents were very anxious, and by chance learned about the treatment of children’s oblique neck, so his mother took the child to the provincial hospital orthopedic department, received a minimally invasive oblique neck correction surgery, but things did not go as planned, the child’s crooked head phenomenon did not improve much after the operation, and later in the hospital physical examination happened to meet a secondary school classmate who is already an obstetrician, she noticed that the cute little Xuan Xuan always crooked curious little head The child’s mother was reminded that it is best to do an eye examination, Xuan Xuan’s mother half-heartedly to the ophthalmology department, only to find that there are many children suffering from strabismus, after the pediatric ophthalmology strabismus specialist examination soon confirmed the diagnosis, Xuan Xuan is suffering from congenital upper oblique muscle palsy, the child’s crooked head and oblique neck is due to the eye cause of compensatory head position, belongs to the eye oblique neck. Finally, Xuan Xuan was hospitalized at the eye hospital for surgery, and the day after the surgery, the child’s head tilt magically disappeared completely! After the surgery, Xuan Xuan was extraordinarily happy and handsome, and the whole family happily picked him up from the eye hospital and discharged him, and friends and relatives congratulated Xuan Xuan’s parents for finally getting rid of a piece of heartache. In fact, most of the conditions of squint are caused by the neck muscles, commonly due to birth injuries or other causes of injury to the sternocleidomastoid muscle, causing abnormal muscle contracture. The abnormal contracture of the sternocleidomastoid muscle causes restriction of neck movement and causes a tilted head. These abnormal muscle changes can often be treated in the early stages with therapeutic measures such as physical therapy. In some cases, surgical intervention is necessary to cure the problem. However, a child’s head tilt can also be caused by an eye abnormality. For children with no significant abnormalities in the neck muscles and a tilted head, oculocutaneous squint should be considered. Oculocerebral tilt is mostly caused by congenital paralysis of the eye muscles. The most common form is paralysis of the superior oblique muscle in one or both eyes. Oculocutaneous squint is a compensatory response by the child to avoid double vision (looking at things with 2 non-overlapping shadows) due to impaired movement of the eye muscles in certain directions. The diplopia disappears when the child’s head adopts a particular position (many times it can exhibit a sloping neck). When a child adopts this head position, it reduces the discomfort caused by strabismus, maintains binocular vision, and protects visual function. However, prolonged head tilting can have many negative consequences for the child. First, it causes facial asymmetry due to the tilted head (squint), which causes one side of the face to be full and the other side to be thin due to the effect of 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. Although the visual function of children with congenital oblique palsy can be protected by compensatory head position (tilted head, sloping neck, etc.). However, this protection is only temporary in many cases. If, for example, the ocular muscle abnormality does not improve in the long term, it may result in a so-called non-common spread of eye movements, involving more ocular muscles. At this point, the tilt of the head may be reduced, but the protection of visual function is simultaneously absent. Ultimately, this often results in the suppression of one eye to avoid diplopia, with the result that amblyopia develops in the suppressed eye. The child will lose stereo visual function for life. For all these reasons, strabismus caused by congenital oculomotor palsy should be treated early. However, congenital ophthalmoplegia is a complex ocular anomaly that must be properly diagnosed by an experienced pediatric ophthalmologist. Often, special equipment (e.g., an emmetropic machine) and special examinations (e.g., reanimation examinations) are required to make the diagnosis. However, due to the special nature of the young age of children, it is very difficult to examine and treat children under the age of 3. The synoptic machine, which is usually used for adults or older children, is completely useless for these children. Some congenital ophthalmoplegia is combined with congenital internal strabismus in addition to strabismus, and the examination and treatment of this condition is even more complicated. Even ophthalmologists are at their wits’ end when it comes to these children without the use of equipment specifically designed for children. In our outpatient clinics, we often encounter many very young children with a crooked head whose first visit is to surgery. The surgical examination reveals no abnormalities in the neck muscles, and in some hospitals, after examination by an ophthalmologist, there is only a suspicion of an eye problem that cannot be diagnosed. The diagnosis was finally confirmed only after we examined and examined the child using equipment specifically designed for pediatric ophthalmology. After the diagnosis was confirmed, the child quickly returned to normal through early surgery. In this way, damage to visual function due to delayed treatment is prevented. With surgery, the crooked head phenomenon is treated, and the resulting problems such as scoliosis slowly disappear. Our ophthalmology department has rich experience in treating the crooked head (compensatory head position) caused by congenital paralytic strabismus. We have received good results from the comprehensive treatment of correcting the ophthalmic squint caused by childhood strabismus by using strabismus correction surgery, wearing trigeminal lenses to correct residual strabismus, and wearing a neck brace to correct neck abnormalities after surgery, and every year the hospital admits many small patients with crooked necks from all over the province. At the same time, parents also need to be reminded that even after orthopedic diagnosis of strabismus, it is necessary to consult with the ophthalmology department, and again differential diagnosis is especially important to avoid misdiagnosis and mistreatment as much as possible!