Brown Syndrome

Brown Syndrome
SYMPTOMS Diplopia, May hear a “click” sound when trying to elevate the eye with adduction
Acquired Brown syndrome secondary to etiologies such as inflammation and tumors can cause orbital pain and tenderness
SIGNS Typically unilateral
Limited or absent elevation with adduction, Downshoot with adduction (seen more in moderate cases), Hypotropia in primary gaze (seen more in severe cases), Upward chin, Head turned away from affected eye, V pattern strabismus, No sign of superior oblique overaction
WORK-UP Pupils, EOMs, Cover test, Cycloplegic refraction, Full eye exam with dilation, Strabismus evaluation, Forced duction testing (positive due to a tight superior oblique tendon)
TREATMENT Typically monitor (75% of congenital cases improve)
Refer to pediatric ophthalmologist for possible surgery if there is a hypotropia in primary gaze, abnormal head posture, and/or severe diplopia
Refer to pediatric ophthalmologist or neuro-ophthalmologist if suspecting an orbital etiology such as a tumor
FOLLOW-UP If monitoring, the patient should be seen back in 6-12 months
If getting ocular surgery, the patient should be seen back once stable for a follow-up and refraction
ADDITIONAL LAB | TESTS None unless if suspecting an underlying etiology for acquired Brown syndrome
ETIOLOGY Congenital vertical strabismus syndrome. Occurs due to a shortened and tight superior oblique muscle and tendon as well as trochlear nerve damage
DIFFERENTIAL DX Inferior oblique palsy, Orbital floor fracture, Superior oblique overaction, Thyroid eye disease, Myasthenia gravis
NOTES Brown syndrome can also be acquired and occurs due to various etiologies including inflammatory disease, trauma, previous sinus disease, and orbital tumors.
Brown syndrome typically occurs more so in the right eye