Abstract
Brown syndrome is a rare form of strabismus that is characterised by restriction of elevation of the eye in adduction. This is a case report of an eleven year old Nigerian girl who presented with a history of squint and poor vision. She had visual acuities of 6/24 and counting fingers in her right and left eyes respectively. There was a left hypotropia in the primary position of gaze with associated marked restriction of elevation in adduction and a positive forced duction test. Refraction revealed a refractive error of +4.50 diopters in each eye. The right visual acuity improved significantly to 6/9 with the refractive correction while the left visual acuity improved marginally to 6/60. This report demonstrates the occurrence of Brown syndrome with associated severe amblyopia in Africa. Health care providers are encouraged to promptly refer all patients, especially children, who have ocular motility disorders for early specialist intervention.
Highlights
Brown syndrome is an uncommon ocular motility disorder characterised by restriction of elevation of the adducted eye [1]
Brown syndrome occurs when there is a mechanical restriction of the superior oblique muscle tendon which leads to difficulty in moving the affected eye upwards, in the adducted position
The main differential diagnosis that must be considered in this patient is an isolated left inferior oblique paralysis [8]
Summary
Brown syndrome is an uncommon ocular motility disorder characterised by restriction of elevation of the adducted eye [1]. If the superior oblique tendon is shorter than normal or cannot slide freely, as occurs in Brown syndrome, the affected eye would not be able to elevate in adduction. This rare form of strabismus was first described by Harold W. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction A three month follow up visit was scheduled, the patient defaulted after the initial visit
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