Ophthalmology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in 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.
Head and Neck Muscles
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo in Handbook of Muscle Variations and Anomalies in Humans, 2022
The absence of superior oblique or its tendon may mimic superior oblique palsy and be associated with vertical deviations, horizontal strabismus, or amblyopia (Helveston et al. 1981; Matsuo et al. 1988; Pollard 1988; Wallace and von Noorden 1994; Chan and Demer 1999). A bifid insertion of the superior oblique may cause congenital Brown syndrome (Park et al. 2009a).
Congenital Cranial Dysinnervation Disorder
Vivek Lal in 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).
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.
Surgical outcome of graded Harada-Ito procedure in the treatment of torsional diplopia ‒ a retrospective case study with long-term results
Published in Strabismus, 2022
Sara Flodin, Per Karlsson, Agneta Rydberg, Marita Andersson Grönlund, Tony Pansell
Symptomatic cyclodeviation is a troublesome condition. Patients are unable to regain cyclofusion unless the cyclodeviation is reduced through surgery. Data were retrospectively reviewed to evaluate the results of a dose-scale approach to the modified Harada-Ito procedure, the influence of our pre-operative assessments, etiology and what constitutes a successful surgical result in this group. Surgical success was achieved in 25 out of the 27 patients (93%). Our study shows a high success rate in terms of symptom relief, which remains at the last evaluation on average 24 months post-operatively. By comparison, previous studies in the field have reported success in 43% to 73% of patients9,11,13,14. The modified Harada-Ito procedure has also been reported to have an effect in reducing vertical incomitance of horizontal deviation.14 Post-surgical complications described from previous publications have included iatrogenic Brown syndrome, restrictive esotropia, and restricted motility.5,9,13 We found none of these problems in our material. However, one elderly patient suffered a residual mechanical restriction in elevation post-surgery. The superior rectus muscle was extremely flaccid, and so the muscle function was affected by the Harada-Ito surgical procedure.
Brown Syndrome Following Upper Eyelid Ptosis Repair
Published in Neuro-Ophthalmology, 2018
Yao Wang, Timothy J. McCulley, Jefferson J. Doyle, Jessica Chang, Michael S. Lee, Collin M. McClelland
In the superonasal orbit, the superior oblique tendon lies in close proximity to the medial edge of the levator palpebrae superioris aponeurosis.6 Surgical manipulation in this region during ptosis surgery, blepharoplasty, or orbital mass biopsy can lead to damage of the superior oblique tendon and/or trochlea. Involutional changes of the upper eyelid, such as medial dehiscence of the Whitnall ligament, fatty infiltration of the levator muscle, and lateral tarsal shift can disturb normal anatomy and increase the risk of inadvertent injury to the trochlea.7 Despite this close anatomical relationship, Brown syndrome following eyelid surgery has only rarely been reported in the literature.
Related Knowledge Centers
- Birth Defect
- Inferior Oblique Muscle
- Sinusitis
- Strabismus
- Strabismus Surgery
- Superior Oblique Muscle
- Corticosteroid
- Binocular Vision
- Rheumatoid Arthritis
- Facial Trauma