- Abnormality of the superior oblique tendon
- Limitation of elevation in adduction
- Deficient elevation in adduction that improves in abduction
- Hypotropia
- Chin up head position and/or face turn away from affected eye
- Forced ductions show restriction to elevation in adduction that is worse with retropulsion*
- V pattern*
- Superior oblique function normal*
- (*)Help distinguish from Inferior Oblique Palsy
- Congenital tendon or trochlear abnormalities
- Acquired
- Trauma
- Inflammatory
- Sinusitis
- Systemic inflammatory diseases: Rheumatoid arthritis
- Abnormality of the superior oblique tendon
- Limitation of elevation in adduction
- Treat underlying inflammatory disease if present
- Steroid injection into trochlear area
- Oral non-steroidal anti-inflammatory agents
- Congenital Brown syndrome may improve spontaneously
- University of Iowa Patients
- 83% Unchanged
- 10% Improved
- 3% Resoloved
- 3% worsened
- May improve years later (mean 11.7 years in Iowa data)
- Observation may result in worse stereo vision outcomes than surgery.
- Patients may do best without surgery unless vision is threatened
- Superior Oblique tenotomy/tenectomy
- Possibility of superior oblique palsy
- More likely if case is not severe
- Combined with or followed by IO recession
- “Chicken Suture”
- Superior Oblique tendon spacer
- Silicone spacer
- Suture spacer
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