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Brown Syndrome

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					   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                    SR




                      MR
               RM
LR




                                         LR
       IR                     IR
              IO       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

				
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posted:3/31/2008
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