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Brown Syndrome. Aka oblique tendon sheath syndromeNamed by Brown 1950.Deficiency of elevation in adduction Divergence in upgazeDown shoot in attempted elev. in adduct. (different than IO palsy)Click felt on trochlea in some acquired casesOften seen with chin up position2/3 are mild and do not require treatment if ortho in primary.
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1. How to diagnose and recognize vertical deviations Part III
Brown Syndrome
G. Vike Vicente, MD
Eye Doctors of Washington
2. 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
3. Brown syndrome OS
4. 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.
5. Normal superior and inferior oblique relationship from primary
6. Normal superior and inferior oblique relationship in adduction
7. Brown Syndrome OS (from above)
8. 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)
9. Brown Syndrome Tx: SO tenotomy(for the less shy)
10. For those surgeons who are a little too chicken to completely cut the SO tendon and cause a SO palsy…Chicken suture technique
11. Brown Syndrome Tx: Chicken suture
12. For those surgeons with a sense of humor…Try the rubber chicken trickaka silicone expander
13. Brown Syndrome Tx: Silicone expander
14. Brown syndrome OS