Brown Syndrome

Brown syndrome was first described by Dr. Harold W. Brown who originally described it as 'Superior Oblique Tendon Sheath syndrome'. Calling this a 'syndrome' is a misnomer in that the problem is isolated to the eye specifically the superior oblique muscle/tendon and the trochlea. It is a mechanical problem where the superior oblique muscle/tendon is unable to freely pass through the trochlea and becomes restricted.

Causes of Brown Syndrome

  • Despite a substantial amount of research which has helped us better understand Brown Syndrome, the cause is often unknown.

  • Most commonly it is congenital, meaning a child is born with it.

  • Acquired Brown syndrome is uncommon but may be seen following surgery, after trauma, sinus infections or in association with inflammatory diseases.

  • Trauma can cause a Brown Syndrome if a blunt object hits the eye socket in the upper inside corner near the nose.

  • Surgery for the eyelid, frontal sinus, eyeball (retinal detachment) and teeth (dental extraction) have also been linked to acquired Brown syndrome.

  • Inflammation of the tendon-trochlea complex (from adult and juvenile rheumatoid arthritis, systemic lupus erythematosus and sinusitis) can be associated with development of the problem.

  • The actual cause of the restriction of the superior oblique at the trochlea is likely different in all of these situations.

Symptoms of Brown Syndrome

  • The eyeball itself appears normal but its movement is restricted when looking in towards the nose and up.

  • The eye misalignment is most noticeable when the affected eye looks towards the nose.

  • It appears to look down or straight ahead while the unaffected eye looks up.

  • Although this is typically not uncomfortable, it can cause double vision and hence will be avoided by the child.

  • For this reason, patients with a Brown syndrome will occasionally hold their chin up or turn their head to avoid looking in the direction that causes their eyes to misalign.

  • Often the higher eye is mistakenly presumed to be the abnormal eye, but it is actually the lower eye that is affected.

Diagnosis of Brown Syndrome

  • The most common way this is detected in children is that parents will notice the child holds a head turn or chin up head position to compensate for the Brown syndrome.

  • When the child looks up at the parents they will see the eye misalignment.

  • Often the Brown Syndrome may be so mild that it is not noticed for several years.

  • In these cases the eyes are typically not affected when looking straight ahead and often don’t require treatment.

  • The hallmark sign of Brown syndrome is a decreased ability to look upward and inward with the affected eye(s).

  • In some situations the eyes turn outward (exotropia) when looking up.

  • Occasionally, the affected eye can get stuck after looking up or down for long periods of time.

  • When the eye becomes unstuck, a click is often heard and may be accompanied by pain or discomfort.

  • Brown syndrome may be more noticeable in children since they often look upward toward adults.

Treatment of Brown Syndrome

  • Treatment recommendations for Brown syndrome vary according to the cause and level of severity.

  • Close observation alone is usually sufficient in mild cases.

  • Visual acuity and the ability to use both eyes at the same time (binocular vision) should be monitored closely in young children.

  • Nonsurgical treatment is often advised for recently acquired, traumatic and intermittent cases.

  • Systemic and locally injected corticosteroids (and other medications that suppress the immune system) have been used to treat inflammatory cases of acquired Brown syndrome.

  • Non-steroidal anti-inflammatory agents (like ibuprofen) have also been used.

  • Surgical treatment is usually recommended if any of the following are present: eye misalignment when looking straight ahead, significant double vision, compromised binocular vision or pronounced abnormal head position.

  • More than one surgery may be needed for optimal management, and surgery on the unaffected eye may be recommended.

diseases treatments syndromes disorders health brown-syndrome

Subscribe For More Content