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Case of the week 72 ( September 2012 )
 Brown syndrome


The mother of this 7 years old child noted that he always acquires a chin up position, this was noticed since early childhood. he is fine passing normally at school , no history of any other abnormalities.
Examination shows that he is emmetropic with bilateral normal vision, no ocular abnormalities could be found , motility examination are displayed here



 See video of this patient
 


 Brown syndrome is now broadly considered as an inability to fully elevate the eye in adduction, and to a lesser extent in the primary position and sometimes abduction. This is caused in most cases, but not exclusively by a restriction related to the superior oblique tendon and/or trochlea. Because of this, the chin may be elevated to capitalize on normal binocularity in gaze down and toward the affected side. Brown syndrome is differentiated from inferior oblique paresis (which is rare) on the basis of restricted passive ductions on attempted elevation in adduction occurring in Brown syndrome.

Most Brown syndrome is idiopathic and congenital. Surgical treatment is indicated for the following: (1) chin elevation, (2) hypotropia in primary position, (3) diplopia, or (4) marked shootdown with adduction.

As children with Brown syndrome - as here in our case -  grow taller, more of their world is straight ahead and below, meaning the implication of Brown syndrome is less. Patients with untreated mild congenital Brown syndrome are seldom bothered by this condition as adults.

Patients with congenital Brown syndrome are in marked contrast to patients with Duane syndrome who tend to become increasingly troubled by their strabismus in adulthood, far out of proportion to what seems a minimal deviation while patients with congenital Brown syndrome are not particularly bothered as adults.

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The Egyptian Site of Strabismus & Oculomotor Disorders