Brown’s Syndrome [1]

What is Brown’s Syndrome?

Brown’s Syndrome is a well-defined clinical disorder with several causes that can be either congenital (present at birth) or acquired.  True Brown’s Syndrome is characterized by a limitation of elevation of the affected eye, particularly when the eye is turned in towards the nose (adduction).  This is usually due to an abnormality in the tendon of one eye muscle (the superior oblique) which is located in this area.  Elevation of the eye is typically normal when it is facing outward toward the ear.  Sometimes the eye can even shoot downward when it is attempting to look up and in.  This may cause the patient to adopt an abnormal head posture so that the eyes can line up straight and be used together, while avoiding double vision.

Treatment

Often no treatment is required.  Most commonly patients with the congenital forms require surgery.  The reasons to perform surgery include, in moderate to severe cases: abnormal head positions, pain and double vision.  Acquired Brown’s Syndrome is usually the result of inflammation and often improves or disappears without treatment.  Additionally, mild head positions and mild eye misalignments are generally not treated.

The surgery consists of passive rotation of the eye under anesthesia to confirm the diagnosis.  The superior oblique tendon is either incised or lengthened and repositioned depending on the reason for surgery, the severity of the case, and the surgeon’s expertise.

It is important to understand that the results of this surgery are not perfect.  Up to 50% of patients may require additional surgery.