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Brown syndrome
Strabismus
Key Points
- •Brown syndrome is a restrictive strabismus with limited elevation in adduction due to inability of the SO tendon to pass freely through the trochlea - the forced duction test is positive (mechanical restriction).
- •The key differentiator from inferior oblique palsy is the forced duction test: positive (restricted) in Brown, negative (paretic) in IO palsy - both present with limited elevation in adduction.
- •50% of congenital Brown syndrome improves spontaneously - observation is first-line unless significant hypotropia in primary position or head posture >15 degrees.
- •Rheumatoid arthritis (trochleitis) is the most common systemic cause of acquired Brown syndrome; peritrochlear steroid injection is effective in 70–80%.
- •Surgery involves SO tenotomy or SO tendon spacer (silicone expander) - spacer substantially reduces the risk of iatrogenic SO palsy compared with full tenotomy.
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Keep reading Brown syndrome
17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations