Brown syndrome is a problem with the tendon that attaches to the outside of the eye (superior oblique muscle tendon). In Brown syndrome, this tendon can't move freely. This limits the eye’s normal movements.
The superior oblique muscle tendon attaches to a small eye muscle. This muscle is responsible for:
The superior oblique muscle tendon moves through a ring of tissue. This is called the tendon sheath.
Many things can limit the normal movement of the muscle tendon through the tendon sheath. When that happens, Brown syndrome occurs.
Brown syndrome is a rare eye disorder. In most cases, a child is born with it (congenital). In very rare cases, it may happen later in life (acquired). Acquired Brown syndrome may be linked to other health conditions. These include injury, inflammatory diseases, problems from eye surgery, and sinus infection. It affects females a bit more often than males.
Problems with how the superior oblique muscle tendon or its sheath are formed can cause symptoms of Brown syndrome. The muscle tendon or its sheath might be abnormally short or thick from birth. Some cases of Brown syndrome might be partly due to problems in the genetic information passed from parents to children. Experts don't yet know what genes might be affected. Most children born with Brown syndrome have no family history of the disease.
At least some cases of Brown syndrome tend to run in families. Your child may be at greater risk for Brown syndrome if someone in your family has it. You might also be at greater risk if you have any health conditions that can cause it, such as lupus. Getting treatment for your health condition right away may help reduce your risk of getting Brown syndrome.
In most cases, only one eye is affected. This is most often the right eye. But both eyes can be affected. The symptoms can vary in severity.
Brown syndrome limits the normal movements of the eye. For example,
Other symptoms include:
If these problems are present from birth, they are often constant. But they may slowly get better.
Diagnosis begins with a health history and physical exam. This includes a full eye exam. Young children can't really follow the directions of a normal eye exam. So healthcare providers can find it hard to diagnose Brown syndrome in young children. You may need an experienced eye care provider to make the diagnosis for your child.
Your child may need imaging tests to get more information about the superior oblique muscle tendon.
Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is. And on what is causing it.
Close watching often works in mild cases.
More severe cases of Brown syndrome may need surgery. Your child may be more likely to need surgery if:
During this surgery, the eye surgeon may cut the superior oblique muscle tendon and use a device to lengthen it. This may allow the muscle tendon to move normally. The surgery is often successful. But some children need repeat surgery.
Brown syndrome due to other conditions is more likely to go away without surgery. Treating the underlying health condition may help reduce symptoms. For example, someone with Brown syndrome due to lupus might find it helpful to be treated with corticosteroids.
If your child has Brown syndrome, watch his or her symptoms closely. Your child will need close follow-up care. If symptoms get worse, plan to see your child's eye care provider soon. Your child might need surgery.
Tips to help you get the most from a visit to your child’s healthcare provider:
Article Last Updated: October 14, 2019
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