Paradoxical head tilt in unilateral traumatic superior oblique palsy

PURPOSE: We report a patient with abnormal head posture following ocular blunt trauma. METHODS: This is report of a case that despite findings compatible with diagnosis of left superior oblique (SO) palsy, the patient acquired an ipsilateral (left) head tilt. The interesting observation in our patient was reduction of left hypertropia and consequent less diplopia with ipsilateral head tilt. RESULTS: After blunt trauma, our patient adopted paradoxical left head tilt and consequently less diplopia despite acquired left SO palsy. Left inferior oblique myectomy resulted in significant improvement of patient's strabismus and abnormal head position. CONCLUSION: Traumatic SO palsy may present with paradoxical head tilt.