Brown's Syndrome

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Brown’s Syndrome Dr Sunayana Bhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : 9611102754 chanyn9@gmail.com

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Historical Background 1950 : Harold W. Brown Published on an unusual motility disorder, characterized limited elevation in adduction 1970s : Short anterior sheath of the superior oblique tendon mid 1970s : A tight or short superior oblique tendon

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PathophysiologyBrown syndrome can be divided into Congenital Acquired.

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To understand Brown’s syndrome understand relationships. Particularly the relationship between the superior and inferior oblique.

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Normal superior and inferior oblique relationship in adductionDr. G.Vicente

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Brown syndrome OSDr. G.VicenteDivergence in upgazeDown shoot in attempted elevation in adduction?

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Brown Syndrome OS (from above) Dr. G.Vicente

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Congenital Helveston theoryWright hypothesisElongation - telescoping mechanism Central tendon fibres ( anomalous ?????) Computer model computer simulation of Brown syndrome, using two specific models a short superior oblique tendon a stiff superior oblique tendon (stretched sensitivity). Stiff muscle tendon complex ( type of CFEOM ?????)

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Acquired brown’s

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Some statistics …1 in 450 strabismic pts .. 35% have a squinting relative Laterality , sex predilection in conclusive

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HistoryDiplopia Rare : suppression. Pain Acquired Brown syndrome present with inflammatory signs. - supranasal orbital pain - tenderness - intermittent limitation of elevation in adduction

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Hallmark FeaturesElevation limitation in adduction Divergence in upgaze FDT +VE Other … Downshoot in adduction Widening of palpebral fissure on adduction Ortho or hypo in primary position Head posture ( chin up ) Audible Click

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Pseudo Brown Congenital Acquired Anomalous inferior orbital adhesions Posterior orbital bands Floor fracture Retinal band around inferior oblique muscle Inferior temporal adhesions

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Differential Diagnosis Inferior oblique paralysis DEP Fracture orbital floor CFEOM Grave’s disease Hypo in primary >15 PD SO Overaction Ductions> versions

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Brown Syndrome Treatment Treat the underlying condition. Surgery indications Hypotropia in primary Anomalous head posture: severe chin up.

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Brown Syndrome Tx: SO tenotomy (for the less shy)SRMRLRIRSRLRRMIRIOIODr. G.Vicente

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For those surgeons who are a little too chicken to completely cut the SO tendon and cause a SO palsy… Chicken suture technique

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Brown Syndrome Tx: Chicken sutureDr. G.Vicente

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Or else……. Try the synthetic … chicken trick “ silicone expander ”

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Silicone expanderDr. G.Vicente

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Last Updated: 8th March 2018

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