You can always see children who come to the clinic with tilted heads. In addition to neck muscle abnormalities, some of these children do have eye diseases. The most common eye disease that causes head tilting is paralytic strabismus. In children, vertical strabismus due to congenital paralysis of the superior oblique muscle is the most common. For example, in children with monocular superior oblique muscle paralysis, because of the existence of the superior oblique muscle paralysis, the affected eye is in a high position when the head is set straight, then the height of the two eyes is not consistent, which will lead to double vision; and when the head is tilted to the side of the healthy eye, it can make the height of the two eyes consistent. As a result, the child will tilt his/her head to one side since childhood. Careful parents can also find that the child’s affected eye looks inward and upward, with a drilling performance. Such children have a characteristic: when they cry and do not look at things, their heads are straight, and the more serious they look at things, the more obvious the tilt of the head. This is not the same as a persistent tilt of the head caused by abnormalities in the neck muscles. Secondly, the more common cause of head tilting is congenital rectus externus paralysis, in which the child will have opposite eyes (internal strabismus), and will turn his face to the side when he looks at things in order to eliminate the strabismus and avoid diplopia. In both cases, strabismus can be corrected and head tilting can be eliminated or minimized by strabismus surgery or pressure-applied trephination. Another cause of head tilting is the presence of idiopathic nystagmus. This type of nystagmus has an intermediate band, which means that the nystagmus is lightest when the eyeball is in a fixed position, and the eye can see most clearly in this position. When this position is not directly in front of the eye, the child will tilt his head and turn his face to keep the eye in this position whenever he is looking at something. In this case, it is also possible to remove the tilted head and improve forward vision by moving the position of the nystagmus, which is the lightest, to the front through surgery or by applying pressure to the prism. Crooked head for a long time will not only affect the development of the face, making both cheeks asymmetrical in size and affecting the appearance, but also affect the normal development of the spine when the head is crooked with scoliosis. Therefore, the existence of crooked head of the child to seek medical correction as soon as possible. In addition to the orthopedic consultation except neck muscles, bone abnormalities, must not forget to go to the ophthalmology examination to see whether there is strabismus, nystagmus and other eye diseases, in order to get timely treatment.