browns and dunes syndrome Flashcards
what is browns syndrome
restriction open elevation in adduction
normal or near normal elevation in a budction
positive forced action test
absence of muscle sequelae expect overaaction of the contralteral superior rectus
downdrift on adduction
widening of plaperal fissure on abbdction
v pattern
ahp
what are the key features of browns
restriction of elevation on adduction
downdraft on abduction
what is the ateiology of congenial browns
short anterior tendon sheath\
inelastic superior oblique tendon
nodule or swelling open the tendon
what is the aetiology of acquired browns
superior oblique tuck
injury to trochee area
rheumatoid conditions
what would you expect to find on invetsogatopn
va normal unless associated manifest deviation
chin elevation
often binocular possible hypophoria
may have raced control manifest with app
usually good bsv
test for potential for bsv if manifest
what is the differential diagnosis
muscle sequelae present
a pattern
negative fat
double elevator palsy
elevation limited in all elevated positions
no alphabet pattern
fat may be negative dependent on ateiplogy
what os the maamgement
observe - 75% show spontaneous improvements
surgery indicated off decompensation, marked app or poor cosmesis
what surgery would you perform
recession of contralteral superior rectus
reverse superior oblique tuck
operate on horizontal muscles if large horizontal angle
tendon splitting
trochlea reconstruction in acquired browns
what are the management options
striped injection
to redcue inflammatory reavtipm opr prevent fibrosis in trauma
exaggerated traction test
in a nutshell what is browns
restriction of elevation on adduction
downdrift on abduction
widening of palpebral fissures on adduction
no development of muscle sequelae
what are the features of duanes
congenital
restriction of abbduction and adduction
globe prtousoon and widening og palberapl fissures on abduction
can be inlayer or bilayers;
narrowing of plaberal fissures
bsv in primary position
what happens to the globe on a dunes and browns syndrome
protusion and retraction of the globe
what are the possible features
ahp usually face turn to achieve bsv
updrift or down drift on adduction
what Are possible features of browns and dunes
defective convergence
positive fdt
what are the diff types of duanes
type a b c
type a marked limitation of abduction and less adduction
type b limitation abduction but normal adduction
type c - more limited adduction than abduction
