What is Brown syndrome?
Brown syndrome is also known as Superior Oblique Tendon Sheath syndrome. It is a mechanical problem in which the superior oblique muscle/tendon does not move freely. This makes looking up and in with the affected eye difficult. Brown Syndrome may be present at birth (congenital) or begin later. It may be constant or intermittent.
What do the eyes of patients with Brown syndrome look like?
One eye appears higher than the other, particularly when looking up. A vertical misalignment is sometimes noted when looking straight ahead.
Brown syndrome causes the lower eye to have trouble looking upward in side gaze. Essentially the affected eye is “tethered” or held down by the tight superior oblique tendon.
What causes Brown syndrome?
Although the exact cause of Brown Syndrome is unknown, these abnormalities may include a reduced elasticity of the superior oblique muscle and tendon, a thickened tendon, a short and/or tight sheath, or fibrous adhesions (scarring) of the tendon.
Can Brown syndrome be acquired?
Acquired Brown syndrome is uncommon but may be seen following surgery, after trauma or in association with inflammatory diseases. Trauma can cause a Brown Syndrome if a blunt object hits the eye socket in the upper inside corner near the nose. Surgery for the eyelid, frontal sinus, eyeball (retinal detachment) and teeth (dental extraction) have been linked to acquired Brown syndrome. Inflammation of the tendon-trochlea complex (from adult and juvenile rheumatoid arthritis, systemic lupus erythematosus and sinusitis) can be associated with development of the problem. Sometimes the cause is never identified.
Does Brown syndrome affect one or both eyes?
Ninety percent of patients have only one affected eye, more commonly the right.
Does Brown syndrome cause eye problems besides abnormal eye movements?
Some children with Brown syndrome have poor binocular vision (which can result in poor depth perception), amblyopia or exotropia.
Can Brown syndrome improve or resolve without treatment?
Spontaneous resolution sometimes occurs in acquired and intermittent cases. In the congenital form of Brown syndrome, the eye movement problem is usually constant and unlikely to resolve spontaneously.
How is Brown syndrome treated?
Close observation alone is usually sufficient in mild cases.
Nonsurgical treatment is often advised for recently acquired, traumatic and variable cases. Systemic and locally injected corticosteroids have been used to treat inflammatory cases of acquired Brown syndrome. Nonsteroidal anti-inflammatory agents (like Ibuprofen) have also been used.
Surgical treatment is usually recommended if any of the following are present: eye turns down when looking straight ahead, significant double vision, compromised bincocular vision or pronounced abnormal head position. More than one surgery may be needed for optimal management.
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