1/18/2024 0 Comments Double pupil diseaseA compensatory abnormal head position may be present, often patients adopt a chin up position or a head turn away from the affected eye (to keep the affected eye abducted, avoid hypotropia, and promote binocular fusion).įorced duction testing is very useful in the diagnosis of Brown syndrome, and will demonstrate restriction to passive elevation in adduction.Īmblyopia is generally absent. In severe cases, there may be both a hypotropia in primary position and downshoot in adduction. In moderate cases, there is no vertical deviation in primary position, but there may be a downshoot in adduction. In mild cases, there is no vertical deviation in primary position or downshoot in adduction. Limited elevation in straight-up gaze and abduction can also be present, but are more subtle. The key finding in Brown syndrome is limited elevation in AD-duction. In cases of acquired Brown syndrome, a thorough orbital examination should be performed with special attention to the trochlear area. Special focus should be given to the sensory-motor examination, including strabismus measurements in all cardinal positions of gaze, ocular motility, and binocular function/stereopsis. For example, workup for a suspected inflammatory etiology may require laboratory testing, while suspected trauma may prompt additional imaging.Ī complete ophthalmic examination should be performed. Further workup may be needed in acquired Brown syndrome and often depends on the suspected underlying etiology. The diagnosis of Brown Syndrome is based on the clinical findings and history. For uncertain reasons, Brown syndrome is more commonly found in the right eye than the left eye. Abnormalities of the fascial anatomy is considered to be a rare cause. There is a large differential for secondary causes of Brown syndrome, including inflammation, trauma, tendon cysts, previous sinusitis, orbital tumors, and iatrogenic causes such as orbital or strabismus surgery. It has been proposed that congenital Brown syndrome may be due to a dysgenesis of the muscle tendon, the superior oblique tendon sheath or the trochlea, and recent work suggests that some cases may be associated with congenital cranial dysinnervation disorders. Various theories have been suggested for the pathogenesis of Brown's syndrome. It may be divided into congenital and acquired causes. As it is a painful test, it is difficult to perform in children without general anesthesia.įundamentally, Brown syndrome results from a limitation of the normal function of the superior oblique tendon-trochlear complex. Differentiation between IO palsy and SO restriction of Brown’s can be done using Forced Duction Test. Predisposition to congenital Brown syndrome, however, most cases are sporadic in nature.īased on the 9-gaze pattern, it can be confused for an inferior oblique palsy. Syndrome can be congenital or acquired, is unilateral in 90% of patients, and has a slight predilection for females. More recently, it is thought that the problem is not the sheath, but rather the tendon itself, that undergoes increased tension. Sheath syndrome," it was considered a dysgenesis of the superior oblique Previously referred to as "superior oblique tendon Syndrome is a vertical strabismus syndrome characterized by limited elevation of the eye in an adducted position, most often secondary to mechanical restriction of the superior oblique tendon/trochlea complex.
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