Brown's syndrome

1. Dr Azmat Khan

2.  Superior oblique tendon sheath
Syndrome
 Named by Brown 1950.
 It is usually congenital but
occasionally may be acquired.

3.  Brown’s syndrome is usually unilateral with
less than 10% of bilateral cases;
 There is no preference for the right or left
eye.
 Females are affected with the same
frequency as males
 There does not appear to be any genetic
basis for the disorder.
 Most patients maintain binocular single vision

4.  CONGENITAL:
 Idiopathic
 Congenital click syndrome, where there is
impaired movement of the superior oblique
tendon through the trochlea.
 ACQUIRED:
 Damage to the trochlea or superior oblique
tendon.
 Inflammation of the tendon, which may be
caused by Rheumatoid arthritis, sinusitis, and
scleritis.
CONT’D
CLASSIFICATION

5.  Right Brown syndrome will have the following
characteristics
◦ MAJOR SIGNS:
 Usually straight in the primary position
 Limited right elevation in adduction
 Normal right elevation in abduction
 No superior oblique over-action
 Positive forced duction test on elevating the
globe in adduction
BROWN’S SYNDROME CONT’D

6. ◦VARIABLE SIGNS:
 Down-shoot in adduction
 Hypo-tropia in primary position
 Abnormal head posture with ipsilateral head tilt
and chin elevation

8.  CONGENITAL CASES:
 Do NOT usually require treatment
 Surgery is indicated in cases of
 Primary position hypo-tropia
 Anomalous head posture
 Recommended procedure for
congenital cases is SUPERIOR OBLIQUE
WEAKENING
BROWN’S SYNDROME CONT’D

9.  ACQUIRED CASES:
 May benefit from STEROIDS, orally or by
injection near the trochlea, together with
TREATMENT OF THE UNDERLYING CAUSE.

11.  Inferior oblique palsy
 Double elevator palsy (MED)
 Orbital blow out fracture
 Ocular fibrosis syndrome

12.  To understand Brown’s syndrome
 You have to understand relationships.
 Particularly the relationship between
the superior and inferior oblique.

13. Dr. G.Vicente

14. Dr. G.Vicente

15. Dr. G.Vicente

16. Dr. G.Vicente

17. THANK YOU