Transcript Brown Syndrome - Pediatric Ophthalmology

How to diagnose and
recognize vertical deviations
Part III
Brown Syndrome
G. Vike Vicente, MD
Eye Doctors of Washington
Brown Syndrome
Aka oblique tendon sheath syndrome
Named by Brown 1950.
Deficiency of elevation in adduction
Divergence in upgaze
Down shoot in attempted elev. in adduct.
(different than IO palsy)
Click felt on trochlea in some acquired cases
Often seen with chin up position
2/3 are mild and do not require treatment if ortho
in primary
Brown syndrome OS
Divergence in upgaze
Down shoot in attempted elevation in adduction?
Dr. G.Vicente
In honor of Valentine’s day
• To understand Brown’s syndrome
• You have to understand relationships.
• Particularly the relationship between the
superior and inferior oblique.
Normal superior and inferior
oblique relationship from primary
Dr. G.Vicente
Normal superior and inferior
oblique relationship in adduction
Dr. G.Vicente
Brown Syndrome OS (from above)
Dr. G.Vicente
Brown Syndrome Treatment
If associated with other disease
– ie rheumatoid arthritis or sinusitis
– Treat the underlying condition.
Surgery if:
– Hypotropia in primary
– Anomalous head posture: severe chin up.
– Consider
SO tendon tenotomy,
SO tendon silicone expander
SO tendon chicken suture (mercilene, nonabsorbable)
Brown Syndrome Tx: SO tenotomy
(for the less shy)
SR
IO
LR
LR
RM
IR
MR
SR
IR
IO
Dr. G.Vicente
For those surgeons who are a
little too chicken to completely
cut the SO tendon and cause a
SO palsy…
Chicken suture technique
Brown Syndrome Tx: Chicken suture
Dr. G.Vicente
For those surgeons with a sense of
humor…
Try the rubber chicken trick
aka silicone expander
Brown Syndrome Tx:
Silicone expander
Dr. G.Vicente
Brown syndrome OS
Divergence in upgaze
Down shoot in attempted elevation in adduction?
Down shoot in attempted elev. in adduct. (different than IO palsy)
Dr. G.Vicente