To the Editor.—The interesting report "Paroxysmal Torticollis in Infancy" by C. Harrison Snyder, MD (Amer J Dis Child117:458-460, 1969) does not indicate whether his patients received ophthalmologic evaluation.
Although usually not paroxysmal in nature, torticollis is a fairly characteristic accompaniment of certain types of ocular misalignment, especially isolated palsy of the superior oblique muscle. While it is true that, unlike the situation in some of Dr. Snyder's cases, the abnormal head position would relieve rather than exacerbate the child's visual disturbance, such manifestations as agitation and dizziness or even something akin to vertigo might be subjective equivalents for the rather annoying diplopia that could occur with such a condition. Intermittency of the misalignment would not be a usual feature of a cyclovertical muscle paresis in most instances, but the occurrence of symptoms could well be.
Another form of incomitant strabismus, the superior oblique tendon sheath of Brown,