Downloaded 148 times
More Related Content
![Types of pediatric contact lens [autosaved]](https://cdn.slidesharecdn.com/ss_thumbnails/typesofpediatriccontactlensautosaved-200210123904-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to Hereditary brown syndrome
Hereditary brown syndrome
- 1. HEREDITARY BROWN SYNDROME DR. JOSEPH KURIAN PGSTUDENT , ACME PARIYARAM
- 2. DEFINITION • Brown syndromeis a disorder of elevation involving mechanical restriction of extra ocular movement. • Brown was the first to describe this anomaly • He suspected a congenitally short superior oblique tendon sheath to be the cause hence “superior oblique tendon sheath syndrome”
- 3. INCIDENCE • Incidence islow – 6 in 2583 (Croswell & Haldi ) • Familial occurrence is rare 2%(Birgit Lorenz, Michael C. Brodsky) • Usually unilateral but 10% is bilateral
- 4. • Syndrome canbe : Congenital Acquired Constant Intermittent
- 5. SUPERIOR OBLIQUE MUSCLE • Origin: Annulus of Zinn at the orbital apex, medial to optic canal • Insertion :Outer posterior quadrant of the eyeball (insertion line 11mm) • Artery : Lateral muscular branch of the ophthalmic artery • Nerve : Trochlear nerve
- 8. SUPERIOR OBLIQUE MUSCLE • Actions: Primary action Intorsion Secondary actions Abduction Depress the eyeball
- 9.
- 10. AETIOLOGY 1. Anomalies ofSuperior Oblique Tendon Sheath 2. Anomalies of Superior Oblique tendon ► Shortening of tendon due to development anomalies
- 11. AETIOLOGY 3. Anomalies ofInferior oblique & adjacent structures ► Dense attachments causing restriction of action 4. Impaired slippage of tendon through Trochlea ► Anomalies of Trochlea ►Retro bulbar thickening of tendon
- 12. AETIOLOGY 5. Acquired causes ►Post operative after superior oblique tucking surgery, scleral buckling & Molteno implant ► Trauma to orbital roof ► Inflammatory conditions like Rheumatoid arthritis
- 13. CLINICAL FEATURES CONSISTENT • Absenceof elevation in adduction • Normal elevation in abduction • Forced duction test shows restriction in adduction
- 14. CLINICAL FEATURES VARIABLE • Mildlimitation of elevation in primary gaze • Down shoot in adduction • Widening of palpebral fissure • Hypotropia in primary position • Compensatory head posture>Head Tilt ,Chin lift
- 15. DIAGNOSIS I. Inability toelevate eye in adduction II. Normal elevation in abduction III.Forced Duction Test shows resistance in adducted position to elevation
- 16. DIFFERENTIAL DIAGNOSIS i. Paralysis ofInferior oblique muscle ii. Congenital fibrosis of inferior rectus muscle iii. Grave’s ophthalmopathy
- 17. CASE HISTORY 8yr oldgirl presented to our ophthal OPD . Her mother had noticed squinting in the RE in certain gaze positions. No complaints of diplopia . Family History: Father gives history of squint in LE. He is a diagnosed case of Browns syndrome in LE.
- 18. ON EXAMINATION Daughter Head postureNormal Hirschberg Test Central Cover Test Orthophoria in primary gaze
- 19. ON EXAMINATION Daughter RE LE Extraocular Restriction in Equal & full movement elevation on adduction Forced duction Resistance to Normal test elevation on adduction
- 21. ON EXAMINATION Father Head postureNormal Hirschberg Test Central Cover Test Orthophoria in primary gaze
- 22. ON EXAMINATION Father RE LE Extraocular Equal & full Restriction in movement elevation on adduction Forced duction Normal Resistance to test elevation on adduction
- 24. TREATMENT INDICATIONS: i. Involved eyehypotropic in primary gaze position ii. Significant anomaly in head posture Head tilt towards affected side Chin lift
- 25. TREATMENT PROCEDURES Complete Tenectomyof Superior Oblique muscle. * Forced duction test becomes negative * In case of symptoms of superior oblique paralysis consider recession of contra lateral IR muscle or ipsilateral IO muscle.
- 26. TREATMENT Silicon superior obliquetendon expanders to lengthen tendon * Preferred procedure * Advantage: No symptoms of SO palsy
- 27. REFERENCES • BINOCULAR VISION& OCULAR MOTILITY 5th edition by Gunter K von Noorden • DELHI JOURNAL OF OPHTHALMOLOGY vol 22 • KANSKI BOWLING 7th edition
- 28.