Summary about Disease
Brown syndrome is a rare type of eye movement disorder. It is characterized by limited elevation (upward movement) of the eye, particularly when the eye is looking inward (adduction). This limitation is due to a problem with the superior oblique tendon sheath complex, which is responsible for guiding the superior oblique muscle. The condition can be congenital (present at birth) or acquired. It is usually unilateral (affecting one eye), but can be bilateral in some cases.
Symptoms
Limitation of elevation of the affected eye, particularly when the eye is looking inward (adduction).
Chin-up head posture (to compensate for the limitation in upward gaze).
Down-shoot of the affected eye when looking inward and up.
Mild ptosis (drooping) of the upper eyelid on the affected side in some cases.
Diplopia (double vision) is rare, as the brain typically suppresses vision in the affected eye to avoid it.
Clicking or snapping sensation may be felt when moving the affected eye.
Causes
The exact cause of Brown syndrome is not always known, but the following factors are considered:
Congenital: Most cases are present at birth and are believed to be caused by a tight or abnormally short superior oblique tendon or tendon sheath.
Acquired: Some cases can develop later in life due to:
Trauma to the orbit or superior oblique tendon.
Inflammation of the tendon sheath (tenosynovitis) due to conditions such as rheumatoid arthritis, lupus, or scleroderma.
Following sinus surgery or other orbital procedures.
Idiopathic (unknown cause).
Medicine Used
Corticosteroids: In cases caused by inflammation, corticosteroids (oral or injected) may be used to reduce swelling and improve tendon mobility.
Pain relievers: Over-the-counter or prescription pain relievers may be used for pain management related to inflammation. Note: Surgery is a more common treatment for Brown syndrome than medication. Medication is typically used for short-term relief of inflammation.
Is Communicable
No, Brown syndrome is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
If acquired Brown syndrome is suspected due to an underlying inflammatory condition, manage the underlying condition under medical supervision.
Protect eyes from trauma to avoid acquired cases.
Regular eye exams are essential to monitor the condition.
Following any eye surgery, follow postoperative instructions carefully to minimize the risk of complications that could lead to acquired Brown syndrome.
How long does an outbreak last?
Brown Syndrome isn't an "outbreak" situation; it is a chronic condition. In acquired cases caused by inflammation, the duration of symptoms can vary. If due to trauma, the effects could be permanent. Congenital cases are also typically chronic. Treatment focuses on managing symptoms and improving eye movement, rather than "curing" an outbreak.
How is it diagnosed?
Diagnosis is typically made through a comprehensive eye examination by an ophthalmologist, particularly one specializing in pediatric ophthalmology or strabismus (eye misalignment). The doctor will:
Assess eye movements in all directions of gaze.
Check for limitation of elevation, especially in adduction.
Evaluate head posture.
Assess binocular vision and the presence of double vision.
Review medical history to identify any potential underlying causes (e.g., trauma, inflammatory conditions).
Forced duction testing may be performed to assess the mechanical restriction of the superior oblique tendon.
Timeline of Symptoms
Congenital: Symptoms are usually present from birth or shortly thereafter. Parents may notice limited eye movement or an unusual head posture in their infant.
Acquired: Symptoms can develop suddenly (e.g., after trauma) or gradually (e.g., with the onset of inflammation). The onset and progression of symptoms depend on the underlying cause.
Important Considerations
Differential Diagnosis: It is important to differentiate Brown syndrome from other eye movement disorders that can cause similar symptoms.
Treatment Options: Treatment depends on the severity of symptoms and the impact on vision and daily life. Options range from observation to surgery.
Surgical Intervention: Surgery aims to improve eye alignment and head posture by releasing or lengthening the superior oblique tendon. However, there is a risk of overcorrection, leading to the opposite problem (superior oblique palsy).
Amblyopia: If Brown syndrome is present from a young age and causes persistent double vision or visual suppression, amblyopia (lazy eye) can develop in the affected eye. Treatment for amblyopia may be necessary.
Psychosocial Impact: Significant head posture or strabismus can affect self-esteem, particularly in children. Support and counseling may be beneficial.