Brown

Brown syndrome is a rare, non-congenital disorder characterized by a mechanical restriction of the superior oblique tendon, leading to difficulties in elevating the affected eye, especially when it is in an adducted position. This condition can be either congenital (present at birth) or acquired later in life, and it affects the ocular motility, causing abnormal eye movements and binocular vision problems.

Etiology

The exact cause of Brown syndrome can vary. In congenital cases, it is often due to an abnormality in the development of the superior oblique tendon. Acquired cases can result from inflammation, trauma, or other conditions that affect the tendon or its surrounding sheath. In some instances, the syndrome may arise following surgical procedures around the eye.

Symptoms

Individuals with Brown syndrome may exhibit several signs and symptoms, including:

• Difficulty in moving the eye upward, particularly when the eye is in an inward position
• A noticeable head tilt to the opposite side of the affected eye, which is a compensatory mechanism to maintain binocular vision
• Complaints of diplopia (double vision) when looking in certain directions
• Pain or discomfort around the affected eye, especially with upward gaze

Diagnosis

Diagnosis of Brown syndrome typically involves a comprehensive eye examination. Health care providers may use various tests to assess eye movement, alignment, and the specific limitations in elevation. Imaging studies, such as MRI or ultrasound, can be helpful in identifying abnormalities in the superior oblique tendon or its trochlea.

Treatment

Treatment options for Brown syndrome vary depending on the severity of the condition and whether it is congenital or acquired. In mild cases, observation and non-surgical management, including the use of glasses with prisms to correct double vision, may be sufficient. More severe cases, particularly those that significantly impair vision or cause considerable discomfort, may require surgical intervention. Surgery aims to lengthen or release the superior oblique tendon, thereby improving eye movement and alignment.

Prognosis

The prognosis for individuals with Brown syndrome depends on several factors, including the cause and severity of the condition, as well as the patient's response to treatment. Many patients experience an improvement in symptoms with appropriate management, although some may continue to have residual limitations in eye movement.

See Also

• Strabismus
• Superior oblique muscle
• Diplopia
• Ophthalmology