Title: How to diagnose and recognize vertical deviations
1How to diagnose and recognize vertical deviations
- Part III
- Brown Syndrome
- G. Vike Vicente, MD
- Eye Doctors of Washington
2Brown Syndrome
- Aka oblique tendon sheath syndrome
- Named by Brown 1950.
- Deficiency of elevation in adduction
- Divergence in upgaze
- Down shoot in attempted elev. in adduct.
(different than IO palsy) - Click felt on trochlea in some acquired cases
- Often seen with chin up position
- 2/3 are mild and do not require treatment if
ortho in primary
3Brown syndrome OS
Divergence in upgaze
Down shoot in attempted elevation in adduction?
Dr. G.Vicente
4In honor of Valentines day
- To understand Browns syndrome
- You have to understand relationships.
- Particularly the relationship between the
superior and inferior oblique.
5Normal superior and inferior oblique relationship
from primary
Dr. G.Vicente
6Normal superior and inferior oblique relationship
in adduction
Dr. G.Vicente
7Brown Syndrome OS (from above)
Dr. G.Vicente
8Brown Syndrome Treatment
- If associated with other disease
- ie rheumatoid arthritis or sinusitis
- Treat the underlying condition.
- Surgery if
- Hypotropia in primary
- Anomalous head posture severe chin up.
- Consider
- SO tendon tenotomy,
- SO tendon silicone expander
- SO tendon chicken suture (mercilene,
nonabsorbable)
9Brown Syndrome Tx SO tenotomy(for the less shy)
SR
SR
MR
LR
LR
RM
IR
IR
IO
IO
Dr. G.Vicente
10For those surgeons who are a little too chicken
to completely cut the SO tendon and cause a SO
palsyChicken suture technique
11Brown Syndrome Tx Chicken suture
Dr. G.Vicente
12For those surgeons with a sense of humorTry the
rubber chicken trickaka silicone expander
13Brown Syndrome Tx Silicone expander
Dr. G.Vicente
14Brown syndrome OS
Divergence in upgaze
Down shoot in attempted elevation in adduction?
Down shoot in attempted elev. in adduct.
(different than IO palsy)
Dr. G.Vicente