Abstract
Aim:To report an unusual case of progressive Brown syndrome and the successful surgical treatment.Methods:A 42-year-old male with a documented 14-year history of progressive Brown syndrome is presented. To improve diplopia symptoms an ipsilateral superior oblique (SO) 7 mm silicone tendon spacer and a contralateral 3 mm superior rectus (SR) recession were performed.Results:The surgical procedure was successful in reducing the primary position deviation (preoperative 30ΔLHoT 7ΔLXT; one month post surgery 3ΔLHo; one year post surgery 7-8ΔLHo 1-2ΔE) and eliminating the abnormal head posture (AHP). Diplopia was only reported on elevation and depression following surgery.Conclusion:This case of Brown syndrome is unusual as it was progressive and had a documented history over a number of years prior to surgery. Surgical treatment of Brown syndrome is rarely required, but in this case was successful in improving the patient’s diplopia and AHP.
Highlights
Brown syndrome is an ocular motility defect where the affected eye(s) does not elevate in adduction but has full depression in adduction (Ansons and Davis 2014)
Acquired cases have been reported in rheumatoid arthritis (Cooper et al 1990) and sinusitis in the trochlear region (Brown 1973), or following inferior temporal orbital scarring, whereas congenital Brown syndrome is attributed to inelasticity of the superior oblique (SO) (Parks and Brown 1975; Wright 1999)
Wright (1999) identified spontaneous improvement in 16% (5/32) of acquired Brown syndrome patients compared to congenital Brown syndrome patients, with a smaller number of congenital cases undergoing surgery compared to acquired cases
Summary
Aim: To report an unusual case of progressive Brown syndrome and the successful surgical treatment. Methods: A 42-year-old male with a documented 14-year history of progressive Brown syndrome is presented. To improve diplopia symptoms an ipsilateral superior oblique (SO) 7 mm silicone tendon spacer and a contralateral 3 mm superior rectus (SR) recession were performed. Results: The surgical procedure was successful in reducing the primary position deviation (preoperative 30∆LHoT 7∆LXT; one month post surgery 3∆LHo; one year post surgery 7-8∆LHo 1-2∆E) and eliminating the abnormal head posture (AHP). Diplopia was only reported on elevation and depression following surgery. Conclusion: This case of Brown syndrome is unusual as it was progressive and had a documented history over a number of years prior to surgery. Surgical treatment of Brown syndrome is rarely required, but in this case was successful in improving the patient’s diplopia and AHP
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