Browns syndrome Flashcards
what are features of browns syndrome
restriction of elevation in adduction
normal or near elevation in abduction
postive force duction test
absence of muscle sequelae expect overaction of the contralateral synergist
downdraft adduction
widening of palpebral fissure on adduction
v pattern
improved movement with click on repeated testing
ahp
what are the features of browns revolving adduction
restriction of elevation in adduction
downdraft on adduction
describe the aetiology of congenital browns
short anterior sheath
developmental anomaly affecting trochlea/superior oblique complex
ineleastic superior oblique tendon
nodule or swelling on the tendon
lr pulley instability
in the ccdd spectrum
what are congenital cranial dysinnervation disorders
cfeom- Congenital fibrosis of eom
3rd, 4th , 5th , 6th
moebius syndrome
Duane syndrome
brown syndrome
ocular synkinesis syndrome
horizontal gaze palsy with progressive scoliosis
what is the aetiology of acquired browns
superior oblique tuck
injury to trochlea area
swelling on tendon
rheumatoid conditions
lr instability
what would you find on investigation for a browns
visual acuity - usually normal unless associated manifest deviation
ahp - chin elevation , tilt to affected side and turn to unaffected side
ct- often binocular in primary position possible hyophoria / exophoric
may have reduced control become manifest without ahp
what are the two main parts of the investigation
Binocular Function
Usually good binocular functions
Test for potential BSV if manifest
Plot field of BSV in older child or adult
Measurement
PCT in p.p.
May measure on versions and elevation
Plot Hess chart in older child
what is the differential diagnosis for browns syndrome
Inferior Oblique Palsy
Muscle sequelae present
A pattern
Negative FDT
Double Elevator Palsy
Elevation limited in all elevated positions
No alphabet pattern
FDT may be negative dependant on aetiology
what are the management options for browns
Observe
75% show spontaneous improvement (Dawson et al 2009)
Surgery: Indicated if decompensating, mkd AHP or poor cosmesis
Results often disappointing
what are the surgery options for browns
Tenotomy with preservation of intermuscular connective tissue septum
Tenotomy with removal of intermuscular connective tissue septum
Superior Oblique tendon expander
Recession of contralateral S.R.
Reverse S.O. tuck
Operate on horizontal muscles if large
horizontal angle
Tendon Splitting Moghadam (2014) Dubinsky-Pertzov et al(2021)
Trochlea reconstruction in acquired Brown’s
what are the non surgical management options for browns
Steroid Injection
To reduce inflammatory reaction or prevent fibrosis in trauma
Some success in early onset (Trimble 1988) though not sustained
Exaggerated Traction Test
Squirrell et al case report in congenital Brown’s. Performed under GA & steroid injection given following traction test. Repeated 5months later
what are the key features of browns
restrcition of elevation in adduction
no development of muscle sequelae
often improvement / resolve
surgery only if symptomatic
