Recession-resection combined with vertical offset of horizontal rectus muscles for management of combined head turn and head tilt in idiopathic infantile nystagmus syndrome

A male child presented with complex abnormal head posture (AHP), characterised by a 35° left head turn and a 45° left head tilt. Orthoptic evaluation revealed orthotropia with full ocular motility and a high-frequency, moderate-amplitude horizontal pendular nystagmus, which dampened in the preferred AHP. The remainder of ocular examination was unremarkable.Surgical correction was performed using Park's modification of the horizontal Kestenbaum procedure to shift both eyes to the left. To address the head tilt, extorsion of the left eye and intorsion of the right eye were achieved by vertically offsetting the horizontal rectus muscles.Postoperative evaluation showed complete resolution of the head turn, with a residual 5° left head tilt, which remained stable at 1-year follow-up.In conclusion, this surgical approach offers a simple and effective method for simultaneous correction of head tilt and turn in idiopathic infantile nystagmus syndrome, reducing the need for more complex muscle surgery.