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How to diagnose and recognize vertical deviations. Part III Brown Syndrome G. Vike Vicente, MD Eye Doctors of Washington. Brown Syndrome. Aka oblique tendon sheath syndrome Named by Brown 1950. Deficiency of elevation in adduction Divergence in upgaze
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How to diagnose and recognize vertical deviations Part III Brown Syndrome G. Vike Vicente, MD Eye Doctors of Washington
Brown Syndrome • Aka oblique tendon sheath syndrome • Named by Brown 1950. • Deficiency of elevation in adduction • Divergence in upgaze • Down shoot in attempted elev. in adduct. (different than IO palsy) • Click felt on trochlea in some acquired cases • Often seen with chin up position • 2/3 are mild and do not require treatment if ortho in primary
Brown syndrome OS Divergence in upgaze Down shoot in attempted elevation in adduction? Dr. G.Vicente
In honor of Valentine’s day • To understand Brown’s syndrome • You have to understand relationships. • Particularly the relationship between the superior and inferior oblique.
Normal superior and inferior oblique relationship from primary Dr. G.Vicente
Normal superior and inferior oblique relationship in adduction Dr. G.Vicente
Brown Syndrome OS (from above) Dr. G.Vicente
Brown Syndrome Treatment • If associated with other disease • ie rheumatoid arthritis or sinusitis • Treat the underlying condition. • Surgery if: • Hypotropia in primary • Anomalous head posture: severe chin up. • Consider • SO tendon tenotomy, • SO tendon silicone expander • SO tendon chicken suture (mercilene, nonabsorbable)
Brown Syndrome Tx: SO tenotomy(for the less shy) SR SR LR RM MR LR IR IR IO IO Dr. G.Vicente
For those surgeons who are a little too chicken to completely cut the SO tendon and cause a SO palsy…Chicken suture technique
Brown Syndrome Tx: Chicken suture Dr. G.Vicente
For those surgeons with a sense of humor…Try the rubber chicken trickaka silicone expander
Brown Syndrome Tx: Silicone expander Dr. G.Vicente
Brown syndrome OS Divergence in upgaze Down shoot in attempted elevation in adduction? Down shoot in attempted elev. in adduct. (different than IO palsy) Dr. G.Vicente