Brown Syndrome: Surgical Management

Abstract

Although spontaneous resolution of Brown syndrome has been well documented, the true incidence of regression is not known. Therefore, precise indications for surgery in Brown syndrome remain controversial. Currently, indications for surgery include the presence of manifest hypotropia in primary position and/or an anomalous head posture, and possibly the presence of an exaggerated downshoot of the involved eye on adduction. Several surgical procedures with variable results and complications have been reported without consensus. At present, superior oblique tenotomy/tenectomy with or without ipsilateral inferior oblique weakening are the recommended surgical options. Superior oblique silicone expander and surgery directly involving the trochlear apparatus offer potential future alternatives.