Orbits: Brown's syndrome

What is Brown's syndrome?


Brown's syndrome is know as Superior Oblique Tendon Sheath syndrome.  Brown's syndrome was named after Dr. Harold W. Brown.  The syndrome consists of a mechanical problem in which the superior oblique muscle doesn't move freely.  Patients have trouble looking up and in with the affected eye. Brown's syndrome patients are 90% of the time affected in one eye and majority of the time it is the right eye that is affected. The figure below is just an image to show which muscle is affected.

http://www.aapos.org/faq_list/brown_syndrome

 

 

 

What causes Brown syndrome?
The cause of Brown's syndrome is unknown.  Heredity cases of Brown's syndrome are quite rare.  People 
 just seem to have Brown's syndrome randomly. "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" (http://www.aapos.org/faq_list/brown_syndrome).  Brown's syndrome can also be caused post-surgery around the upper portion of the eye, from blunt trauma to the upper corner of the eye area, or from inflammation. The picture below shows how people are affected by the syndrome.

Clinical Characteristics of Brown Syndrome

1." Vision and stereo acuity usually normal"

2. "Chin up face points to opposite side"

3."Deficient elevation in adduction"

4. "Usually some elevation limitation in straight upgaze and in abduction"

5. "Widened palpebral fissure on adduction"

6. "May or may not have downshoot of involved eye in adduction"

7. "May be acquired"

8. "May be intermittent with or without pain"

(all info above from:  http://www.cybersight.org/bins/volume_page.asp?cid=1-3-4-18 ) 

Axial section of T1 contrast MRI  (http://webeye.ophth.uiowa.edu/eyeforum/cases/50-Acquired-Brown-Syndrome-Ethmoid-Mucocele.htm)

 

 

Treatment 

Treatment of Brown's syndrome varies with the severity of the disease. Occasionally Brown's syndrome cures itself.  Nonsurgical and surgical advise is given for differently acquired Brown's syndrome.  Nonsurgical treatment is recommended for patient that acquired Brown's syndrome after traumatic accidents or newly developed cases.  Patients with inflammation from Brown's syndrome will sometimes receive corticosteroids or take anti-inflammatory medications.  "Surgical treatments are 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" (http://www.aapos.org/faq_list/brown_syndrome).

For more information on Brown's syndrome, please visit:

http://www.aapos.org/faq_list/brown_syndrome
http://www.cybersight.org/bins/volume_page.asp?cid=1-3-4-18

Ashli