====== Brown Syndrome ======

===== Description =====
  *  Abnormality of the superior oblique tendon
  * Limitation of elevation in adduction

===== Clinical Characteristics =====
  * 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
===== Etiologies =====
  * Congenital tendon or trochlear abnormalities
  * Acquired
  * Trauma
  * Inflammatory
    * Sinusitis
    * Systemic inflammatory diseases: Rheumatoid arthritis
===== Treatment Goals =====
  * Abnormality of the superior oblique tendon
  * Limitation of elevation in adduction
===== Treatment =====
  * 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
===== Surgical Options =====
 
  * 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
   

{{tag>strabismus}}