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Brown’s Syndrome of the Eye

By Kristie Rivers, MD, FAAP, Board Certified Pediatrician

Brown’s Syndrome is a rare and painless condition of the eyes that can affect both children and adults. Patients with Brown’s syndrome are unable to fully move one of their eyes, causing the affected eye to be stuck in the upward position.

Brown’s Syndrome is also known as superior oblique tendon syndrome because a tendon on the outer part of the eye (the superior oblique tendon) does not fully lengthen so the eye cannot move freely. Usually the eyes appear normal until the affected person tries to look to the side. When this happens, the affected eye is unable to look up and in because of the abnormally shortened tendon, causing one eye to appear higher than the other.

The diagnosis of Brown’s syndrome is by simple physical examination of the eyes. Often children will hold their heads in a certain, recognizable position to accommodate for the limited eye movement. Their chins will be lifted, and the head will be tilted and face turned. Often, a child’s problem will be noticed as they are looking up at an adult.

Brown’s syndrome usually arises sporadically and rarely runs in families. The cause is unknown in most cases but is uncommonly due to trauma, eye surgery, or from an underlying inflammatory disease such as sinusitis, lupus, or juvenile inflammatory arthritis. Most cases affect only one eye, and the right eye is more commonly affected than the left. Some children will have other associated eye problems, such as poor vision or a lazy eye.

In mild cases of Brown’s syndrome, children are closely observed by an eye doctor and treatment is not warranted. Sometimes symptoms will get better on their own. In other cases, the underlying problem must be treated. Inflammatory causes may require steroid injections or an oral anti-inflammatory medication. In severe cases, multiple surgeries may be necessary in an attempt to correct the problem. In all cases, the child’s vision is closely monitored to prevent other problems down the road.

Sources:

  • American Association for Pediatric Ophthalmology and Strabisus
  • Brown Syndrome. Parks MM, Brown M
  • Superior oblique tendon sheath syndrome of Brown
  • Am J Ophthalmol
  • 1975 Jan;79(1):82-6
  • PubMed Medscape. Brown Syndrome.

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