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The design and efficacy of surgery for horizontal idiopathic nystagmus (HIN) with abnormal head posture and strabismus were investigated.Different surgical procedures were selected according to the angle of head tum in 44 cases of HIN with abnormal head posture and strabismus.For patients with a head t of 15° or less,the Anderson procedure was used; the yoke muscles were recessed upon slow-phase.For patients with a head t between 15° and 25°,the surgery was designed as a Kestenbaum 5-4-4-5 procedure.For patients with a head t of 25° or more,the surgery was designed as a Parks 5-8-6-7 procedure.The surgery to correct the abnormal head posture was performed on the fixating eye while that to correct the deviation was then performed on the non-fixating eye at the same time.The amount of surgery of the horizontal rectus muscles on the non-fixating eye was sum of the angle of head t and the degree of deviation,which was calculated as follows:recession/resection amount of medial and lateral rectis/2× 5=angle of head t±degree of deviation.The results showed as follows:(1)Visual acuity:the visual acuity in the primary ocular position increased two lines or more in 35 patients,accounting for 79.55％.Nine patients had no or only one-line improvement,accounting for 20.45％ of the entire study population; (2) The degree of deviation in the primary ocular position:37 cases had a normal primary ocular position or the degree of deviation ≤8Δ after surgery,accounting for 84.09％.Six patients had a residual degree of deviation of 8Δ-15△,accounting for 13.64％.One patient had a residual degree of deviation ＞20Δ,accounting for 2.27％ of the patients examined; (3) Abnormal head posture:34 patients had a normal head posture or a head t of less than 5°,accounting for 72.27％.Eight patients had a residual head t of 5°-15°,accounting for 18.18％.Two patients had a head t of 15°- 25°,accounting for 4.55％.It was concluded that different surgical procedures based on the angle of head tum and the relationship between deviation and null zone can eliminate anomalous head posture,correct deviation,and improve vision acuity in the primary ocular position simultaneously.