Brown's syndrome: diagnosis and management. Dr. Harold Brown first described eight cases of a new ocular motility condition, which presented with restricted elevation in adduction, among other features in 1949. Most frequently idiopathic or iatrogenic (following inferior oblique surgery or retrobulbar block). Previously referred to as "superior oblique tendon Donahue SP, Itharat P. A-pattern strabismus with overdepression in adduction: a special type of bilateral skew deviation? It has been proposed that congenital Brown syndrome is due to a dysgenesis of the muscle tendon, superior oblique tendon sheath or trochlea, and recent work suggests that some cases may be associated with congenital cranial dysinnervation disorders. The patient shows accommodative convergence in primary and downgaze as opposed to upgaze simulating a V-pattern. Strabismus. Das VE, Fu LN, Mustari MJ, Tusa RJ. Specific methods for testing are detailed in the highlighted link above. 2004 Oct;8(5):507-8. doi: 10.1016/j.jaapos.2004.06.001. A complete ophthalmic examination should be performed. Although A or V patterns are the most common patterns observed (Figure 1), there are several other patterns that can be seen in a comitant strabismus. Ugolini G, Klam F, Dans MD. Brown HW. A translucent occluder for study of eye position under unilateral or bilateral cover test. Urrets-Zavalia A. Abduction en la elevacion. Urist MJ. Brown's Syndrome - an overview | ScienceDirect Topics Strabismus Surgery: Basic and Advanced Strategies. Neurology. Strabismus after retinal detachment surgery. Determining if the hypertropia is worse in left or right gaze helps eliminate two of the possibly affected muscles. : Following glaucoma, oculoplastics or strabismus surgery; ENT surgery), Inflammation of the trochlea (Ex. Brown Syndrome - an overview | ScienceDirect Topics Br J Hosp Med. Some authors recommend following such patients for resolution over time and control of the vasculopathic risk factors alone. Myectomy and extirpation/denervation have been described but are not preferred procedures by the authors, as the results may be unpredictable, and anteriorization cannot be achieved by these procedures. Wilson ME, Eustis HS, Parks MM. Please enable it to take advantage of the complete set of features! There are eight possible muscles that could cause a hypertropia -- the bilateral superior recti, inferior recti, superior obliques and inferior obliques. JS Crawford, Surgical treatment of true Brown's syndrome, American journal of ophthalmology, 1976. Right inferior oblique muscle palsy. Combined Brown syndrome and superior oblique palsy without a trochlear nerve: case report. Sergott RC, Glaser JS. In cases of acquired Brown syndrome, a thorough orbital examination should be performed with special attention to the trochlear area. Brown syndrome refers to the apparent weakness of the inferior oblique muscle (i.e., limited upgaze, particularly in adduction) secondary to pathology of the superior oblique tendon sheath, usually at the trochlea.