Natural History and Treatment of Brown’s Syndrome: Long-Term Experience

Abstract

Purpose: Brown’s Syndrome (BS) is a restrictive strabismus characterized by a limitation of elevation in adduction. Several etiologies have been described, usually involving the superior oblique muscle. Spontaneous improvement has been reported in several studies, so surgery is reserved for a minority of cases. Our purpose is to review the characteristics, natural history and treatment of this pathology and present the experience of the Instituto de Oftalmologia Dr. Gama Pinto (IOGP). Methods: A consecutive retrospective series of BS patients seen at the Strabismus Department of IOGP between 1983 and 2014 was reviewed. All patients with complete clinical data were included in this study. The epidemiologic characteristics, clinical features, treatment, and clinical progression were reviewed. Results: Thirty-nine cases were selected, with a mean age at first diagnosis of 6.5 years. Of the thirty-nine cases, 6 were iatrogenic and the remainder idiopathic. Thirty-six cases were followed for a mean period of 6.1 years. Surgical intervention for BS was performed in 11 patients, using different approaches. Of these, 9 cases were considered successful. The remaining 25 cases were kept under observation without surgery, of which 17 showed spontaneous improvement and the other 7 remained unchanged. Conclusions: The surgical success rate was 82%, which demonstrates the good efficacy of the surgery despite the complexity and variety of pathophysiological mechanisms of the syndrome. In the patients kept under observation there was spontaneous improvement in 68%, confirming that a conservative approach seems to be adequate in most cases.