-
What are the features of Brown syndrome? What is it due to? How is it
acquired?
-
How
is the vision potential of children with this condition?
-
How is this condition treated?
-
How do I get more information?
Brown syndrome
consists of an inability to elevate an eye in adduction. Other associated
clinical features include an exodeviation in attempted upgaze and an ipsilateral
hypodeviation that gets worse in upgaze.
Brown syndrome
is caused by a mechanical restriction of the superior oblique tendon moving
through the trochlea. The most common cause is a congenitally tight superior
oblique muscle tendon complex, termed true congenital Brown syndrome.
The acquired
form is usually caused by an inflammation around the superior oblique tendon and
trochlea. The patient may complain of intermittent pain and tenderness on the
superior nasal quadrant. The other causes of acquired or pseudo-Brown syndrome
include orbital floor fracture, trochlear inflammation (such as in rheumatoid
arthritis), peritrochlear scarring or superior oblique tendon sheath syndrome,
glaucoma implant under the superior oblique tendon in the superior nasal
quadrant, or fat adherence syndrome.
By assuming chin
elevation and face turn away from the affected eye, most patients with Brown
syndrome can fuse the images of the two eyes and have good binocular vision.
Surgery is indicated when the compensatory head posture is unacceptable.
True congenital
Brown syndrome is usually managed conservatively. It is better to wait until
the child reaches visual maturity before any surgery is done because strabismus
is not an uncommon complication of surgery and may lead to loss of binocular
vision post-op. The most common indication for surgical treatment is a
significant vertical deviation in primary position. Surgery consists of one of
the many procedures to weaken the superior oblique tendon. The procedure of
choice is superior oblique tenotomy with insertion of silicone tendon expander
(Wright).
In contrast to
the congenital form, inflammatory Brown syndrome may resolve spontaneously.
Treatment options include oral non-steroidal anti-inflammatory medication, or
local steroid injection in severe cases. Surgery is usually contraindicated.
References:
Wright KW.
Surgical procedures for lengthening the superior oblique tendon. Invest
Ophthalmol Vis Sci 1989; 30 (suppl): 377.
Wright KW.
Results of the superior oblique silicone expander for severe Brown’s syndrome.
Trans Am Ophthalmol Soc 2000; 98: 41-50.
Wright KW.
Brown’s syndrome: diagnosis and management. Trans Am Ophthalmol Soc 1999; 97:
1023-1109
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BROWN SYNDROME information compiled by
Dr. Barbara L. Roque
and initially uploaded on October 25, 2005.
Last updated on
September 13, 2007.
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