Brown's syndrome is a condition where there is limited elevation of the eye in adduction due to impaired movement of the superior oblique tendon through the trochlea. It can be congenital or acquired. Congenital cases are usually idiopathic while acquired cases result from damage to the trochlea or tendon, or inflammation. Symptoms include limited elevation in adduction, a positive forced duction test, and occasionally downshoot in adduction or anomalous head posture. Treatment depends on whether the case is congenital or acquired, with congenital cases often not requiring treatment and acquired cases potentially benefiting from steroids and treatment of the underlying cause.

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