Brown's Syndrome

What are the features and treatment of Brown's syndrome?

Video Transcript:

Brown’s Syndrome is another type of congenital squint. It is caused by an abnormal pulley system for the superior oblique muscle. Brown’s Syndrome can also develop in later life as a result of damage to this pulley system. In the days before seat belt legislation road traffic accidents were a common cause of this type of injury. It can also occur as a result of inflammation of the pulley system.

What are the features of Brown’s Syndrome?

Restricted upward movement of the eye when it is looking inwards
The most striking feature of Brown’s Syndrome is restricted upward movement of the affected eye when the eye is looking inwards.

This is particularly obvious in smaller children when they try to look upwards at their parents.

• - Hypotropia and a head posture
  The vast majority of children with Brown’s Syndrome do not have a squint when they re looking straight ahead, but occasionally in severe cases the eye can be lower than the other eye, this is known as a hypotropia. These children will often adopt a slightly chin up head posture to compensate for this squint.
• - Down shoot of the affected eye
  In some cases of Brown’s Syndrome the affected eye shots downwards when it looks inwards.

How is it treated?

The vast majority of children with Browns Syndrome develop good vision in both eyes, good stereopsis and do not need any form of surgery.

Surgery is only required if there is a significant squint in the straight ahead position and / or if the upward movement of the eye is a very restricted.

How is surgery done?

The aim of surgery is to weaken the superior oblique muscle so it moves more smoothly through the pulley. This can be done either by lengthening the tendon by inserting a length of silicone into the tendon, or by moving the insertion of the muscle closer to the pulley.