This can explain the worsening of a patients diplopia when they attempt to visualize objects in primary position, especially in down-gaze. Other features: Intorsion and abduction in downgaze. 2015 Jul;26(5):357-61. Congenital Brown's Syndrome: Intraoperative Findings Surgical Procedures and Postoperative Results Andreea Ciubotaru Brave Inferior Oblique Vincent Paris Early Strabismus Surgery can improve Facial Asymmetry in Anterior PlagiocephalyLeila S Mohan Superior Oblique Tendon Elongation with Bovine Pericardium (Tutopatch) for Brown Syndrome. https://doi.org/10.1007/978-3-319-63019-9_15. Brown Syndrome - PubMed a. Miller MM, Guyton DL. Does the hypertropia worsen in left or right head tilt? The risk in this procedure is that the sutures may cut through the thin superior oblique tendon. These large vertical fusional ranges characteristic of congenital cases. Vertical Strabismus. Taylor & Hoyt's Pediatric Ophthalmology and Strabismus, by Scott R. Lambert and Christopher J. Lyons, Elsevier, 2017, pp. If superior rectus palsy: Superior transposition of half tendon lengths of medial and lateral recti or Knapp procedure. syndrome is a vertical strabismus syndrome characterized by limited elevation of the eye in an adducted position, most often secondary to mechanical restriction of the superior oblique tendon/trochlea complex. High-resolution MRI demonstrated varied abnormalities in both congenital and acquired Brown syndrome such as traumatic or iatrogenic scarring, avulsion of the trochlea, cyst in the superior oblique tendon, inferior displacement of the lateral rectus pulley and fibrous restrictive bands extending from the trochlea to the globe (Bhola et al, 2005). Brown syndrome is attributed to a disturbance of free tendon movement through the trochlear pulley. In cases of acquired Brown syndrome, a thorough orbital examination should be performed with special attention to the trochlear area. [2] When bilateral, it frequently gives rise to lambda-pattern, with accentuated exotropia in downgaze.[4]. If cosmetically intolerable or if noticeable: If associated with an IO overaction: Sole IO graded anteriorization, If associated with an SO overaction: Treat the A pattern with horizontal muscle transpositions, or an undercorrected SO weakening procedure, since the latter may aggravate the symptoms of DVD, If both eyes can fixate: Bilateral SR recessions, with asymmetric recessions if asymmetric, If overcorrected: Associate an IR plication or resection.
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