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Congenital Cranial Dysinnervation Disorder
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Congenital Brown syndrome often occurs sporadically but several familial cases have been reported in the literature including identical twins (27, 28). Brown syndrome is mostly unilateral with around 10% of the cases being bilateral and no sexual preference is usually seen (29).
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Brown syndrome: this is not an uncommon condition where the tendon of the superior oblique muscle is unable to pass freely through its pulley (the trochlea, at the superomedial orbital rim). This results in restriction of elevation in upgaze usually just in the adducted position. As a result there may be a coincident downshoot in adduction on version testing. It is usually idiopathic but may be acquired due to inflammation at the trochlea or trauma.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2022
David A. Bellows, Noel C. Y. Chan, John J. Chen, Hui-Chen Cheng, Peter W. MacIntosh, Michael S. Vaphiades, Xiaojun Zhang
This was a retrospective review of clinical and magnetic resonance imaging (MRI) findings of six patients (four paediatric and two adult patients) with Brown’s syndrome characterised by a restrictive elevation deficit of the affected eye in adduction with a median follow-up of 23 months. In all six patients, orbital MRI demonstrated inflammatory changes in the superior oblique tendon-trochlea complex. A striking MRI feature was revealed, circumferential contrast enhancement of the trochlea with central sparing where the tendon passes, reminiscent of an eyelet. Both adult patients had a history of seronegative spondyloarthritis, but there were no associated systemic conditions in the children in the series. The authors concluded that in both children and in adults, MRI can provide evidence of inflammatory changes located at the trochlea-tendon complex in acquired Brown’s syndrome, referred to as the “eyelet sign”, which may be helpful in confirming the clinical diagnosis and guide appropriate treatment.
Strabismus patterns after cataract surgery in adults
Published in Strabismus, 2021
Mirjam Johanna Rossel-Zemkouo, Richard Bergholz, Daniel J Salchow
Cataract surgery had been performed under regional anesthesia in 37 cases. The remaining three patients were operated under general anesthesia. In these cases, the diagnoses were decompensated esophoria, exotropia at near due to convergence insufficiency associated with Parkinson's disease, and acquired Brown syndrome of the operated right eye. After cataract surgery under regional anesthesia, 36 of 37 patients had vertical strabismus, one patient had a decompensated exophoria at near. In three cases, a vertical deviation resulted from acquired Brown syndrome, two of them had restriction of elevation in adduction of the operated eye (one right, one left). One of these had a history of sclerouveitis associated with granulomatosis with polyangiitis and had received a microimplant during cataract surgery for secondary glaucoma. The third patient had Brown syndrome on the contralateral (non-operated right) eye.
Radiotherapy for Orbital Pseudotumor: The University of Florida Experience
Published in Cancer Investigation, 2018
Meriem Mokhtech, Sommer Nurkic, Christopher G. Morris, Nancy P. Mendenhall, William M. Mendenhall
Overall, RT was well-tolerated. There were no significant acute treatment events that warranted treatment breaks. Toxicities were mostly mild and likely related to the disease process rather than RT. Cataracts were the most commonly expected late toxicity and were only observed in 2 patients (10%). The second most common toxicity was a chronic dry eye, documented in 2 patients (10%). This incidence was lower than what has been reported in the recent literature (13). Of interest is the development of Brown’s syndrome in 1 patient. Acquired cases of Brown’s syndrome have been documented to result from traumatic, infectious, inflammatory, or iatrogenic causes (21). To our knowledge, there are no other reports of Brown’s syndrome after orbital radiation. There was no correlation between RT dose and acute or late toxicities.