PURPOSE. To report clinical findings and surgical management of 4 patients with congenital nystagmus who presented with a new or reversal of their original horizontal compensatory head posture (CHP) after Anderson-Kestenbaum (A-K) surgery. METHOD. Retrospective chart review. RESULTS. All 4 patients demonstrated a 40 degrees-45 degrees horizontal face turn at the time of their initial surgery and 3 underwent 20% and one 30% augmented A-K surgery to correct the CHP. The new CHP or reversal of the original CHP was observed at a mean of 4 years (range 1-9 years) after the initial surgery The reversed CHPs measured 20 degrees, 40 degrees, 20 degrees, and 20 degrees, respectively. These new or residual CHPs were surgically managed in 3 patients and an acceptable head position was achieved in all patients. CONCLUSIONS. This series of patients points out the occurrence of secondary null points and reversed CHP after surgical correction of initial CHP.