Week 7 - Browns syndrome?

Question 1

What is Browns syndrome?

Answer 1

• First described by Brown in 1950
• Synonym: Superior Oblique Tendon Sheath Syndrome
• Shortening of anterior sheath of superior oblique tendon

Question 2

What are the clinical characteristics of Browns syndrome?

Answer 2

• Limitation of elevation in adduction
• Down drift of affected eye on contralateral version
• o/action of contralateral SR
• V pattern
• Discomfort on attempted elevation in adduction
• Improvement on repeated testing - ‘click’ syndrome
• AHP
• +ve Forced duction test

Question 3

Incidence on browns syndrome?

Answer 3

• Unilateral (<10% bilateral). R=L
• Thought to develop in infancy, few are congenital
• May he acquired in later life due to inflammation or trauma to trochlea (uncommon)
• Studies have found the patients may spontaneously recover normal motility over a period of years
• Females = male

Question 4

Aetiology of Browns syndrome?

Answer 4

• Anomalies of the tendon sheath
• Anomalies of the tendon

• Trauma/inflammatory Rheumatoid arthritis
• Surgery
• Differential diagnosis: Congenital inferior oblique palsy

Question 5

Management of browns disease?

Answer 5

• Conservative - observation
- corticosteroids

• Surgical - Tonotomy/tenectomy of SO
- Split Tendon Lengthening