browns syndrome

Question 1

what is browns syndrome

Answer 1

BROWNS SYNDROME IS LOSS OF ELEVATION ON ADDUCTION

Question 2

browns characteristics

Answer 2

Limitation of elevation in adduction

• Down drift of affected eye on contralateral version
• o/action of contralateral SR
• A or V pattern
• Discomfort on attempted elevation in adduction
• Improvement on repeated testing – ‘click’ syndrome - cant elevate looking up therefore nodule moves over trochlear and they cant look down
• AHP - tilt to affected side (lower eye)
• +ve Forced Duction Test - callipers used to force the eyes into a position of gaze, +ve meaning you cant move the eye into gaze as it is a mechanical problem

Question 3

aetiology of acquired browns

Answer 3

Anomalies of the tendon sheath (of SO)
* Anomalies of the tendon - swelling, nodule
* Trauma/Inflammatory Rheumatoid Arthritis
* Surgery
Differential Diagnosis: Congenital Inferior Oblique Palsy

Question 4

aetiology in congenital browns

Answer 4

Unconfirmed:

* Paradoxical Innervation of the Superior Oblique

* Structural Anomalies of Inferior Oblique

Question 5

management of browns

Answer 5

In the majority of cases no management is required e.g.
→ If the patient has BSV in the PP without a marked head posture
→ Surgery is only indicated if they are decompensating in the PP

• In acquired cases we may require to treat the aetiology
• Conservative – observation
  - corticosteroids
• Surgical
• Tonotomy/tenectomy of SO (operate on tendon to reduce swelling)
• Split Tendon Lengthening