Browns syndrome Flashcards
What is the incidence of browns syndrome
usually unilateral about 10% bilateral
equal frequency in males and females
right eye more frequently affected than left
congenital / early onset or acquired
What are the features of browns syndrome
restriction of elevation in adduction
normal or near normal elevation in abduction
positive forced duction test
absence of muscle sequelae except o/a of the contralateral synergist
possible features
downdrift on adduction
widening of palpebral fissure on adduction
v pattern ( a also reported )
improved movement with ‘click’ on repeat testing
AHP
what are the primary features of browns syndrome
restriction of elevation on adduction
downdraft on adduction
what is the ateiology of congenital browns syndrome
short anterior tendon sheath
develpmental anomaly affecting trochlea/ superior oblique complex
inelastic superior oblique tendon
nodule or swelling on the tendon
lr pulley instability bhola 2005 (1 case)
in the ccdd spectrum
what are the congenital cranial dysinnervation disorders
congenital fibrosis of the extraocular muscles
3rd , 4th , 6th nerve palsy
moeubius syndrome
Duane syndrome
brown syndrome
ocular synkinesis syndrome
horizontal gaze palsy with progressive scoliolois
what is the aetiology of acquired brown syndrome cases
superior oblique tuck
injury to trochlea area (less since seat belt law has been introduced)
swelling on tendon
rheumatoid conditions
left rectus instability
what does the investigation of brown syndrome involve
visual acuity - usually normal unless associated manifest deviaiton
app - chin elevation , tilt to affected side and turn to unaffected side
ct - often binocular in primary position , possible hypohoria/ exophoric
may have reduced control and become manifest without abnormal head posture
bonocular function - usually good binocular functions
test for potential bsv if manifest
plot field of bsv In older child or adult
what measurements would you take in the investigation of browns syndrome
prism cover test in primary positon
may measure on versions and elevations
plot hess chart in older child
what does brown syndrome have to be differentially diagnosed from and how they are different from browns
inferior oblique palsy
- muscle sequelae present
a pattern
negative forced suction test
double elevator palsy
elevation is limited in all elevated positions
no alphabet patterns
fat may be negative dependent on aetiology
what are the management options for browns syndrome
observe - 75% show spontaneous improvement ( Dawson et al 2009)
surgery - indicated if decompensating, marked abnormal head posture or poor cosmesis
results often disappointing
what surgery is recommended for browns syndrome
tenotomy with preservation of intermuscular connective tissue septum
tetonomy with removal of inter muscular connective tissue septum
superior oblique tendon expander
