Brown's syndrome

• "superior oblique tendon sheath syndrome".
• The definition of the syndrome has since been expanded to limited elevation in adduction from mechanical causes around the superior oblique
• also been called pseudo paresis of the inferior oblique
• Left Brown - Limited Elevation in Adduction
• Favored head posture with left Brown: head up and to right where eyes do not go! Eyes positioned down and left to look straight ahead.
• 1. Vision and stereo acuity usually normal
  2. Chin up face points to opposite side
  3. Deficient elevation in adduction
  4. Usually some elevation limitation in straight upgaze and in abduction
  5. Widened palpebral fissure on adduction
  6. May or may not have downshoot of involved eye in adduction
  7. May be acquired
  8. May be intermittent with or without pain

Causes:

• "Short" Superior Oblique Tendon -Including Anomalous, Broad Insertion
• Fascial Restrictions
• Intrasheath Septae
• Trochlear Entrance Restriction
• Inflammation of the Trochlea
• Cyst of the Reflected Tendon
• Trochlear Trauma* (Canine Tooth) * This causes superior oblique underaction and Brown syndrome
• Tuck of the superior oblique tendon is usually done at or near the insertion on globe

http://telemedicine.orbis.org/bins/volume_page.asp?cid=1-3-4-18