A 4-year-old child with congenital motor nystagmus maintains a constant right face turn, with the nystagmus amplitude minimal when the eyes are held in left gaze. Which surgical strategy addresses the abnormal head posture?

• A Recession of all four horizontal recti by equal amounts without shifting the null point
• B Superior oblique tenotomy bilaterally
• C Kestenbaum-Anderson procedure to shift the null point into primary position ✓
• D Botulinum toxin injection into both lateral recti

Explanation

When the null point lies eccentrically, patients adopt a compensatory face turn to place the eyes at the null. The Kestenbaum-Anderson procedure recesses the yoke muscles of the preferred gaze direction and resects their antagonists, moving the null point toward primary gaze and abolishing the head posture. Large symmetric four-muscle recessions reduce nystagmus intensity but do not correct eccentric fixation, and toxin injection is not an accepted standard approach here.

Reference: Taylor and Hoyt's Pediatric Ophthalmology and Strabismus, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.