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How to diagnose and recognize vertical deviations

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Click felt on trochlea in some acquired cases. Often seen with chin up position ... Down shoot in attempted elevation in adduction? In honor of Valentine's day ... – PowerPoint PPT presentation

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Title: How to diagnose and recognize vertical deviations


1
How to diagnose and recognize vertical deviations
  • Part III
  • Brown Syndrome
  • G. Vike Vicente, MD
  • Eye Doctors of Washington

2
Brown 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

3
Brown syndrome OS
Divergence in upgaze
Down shoot in attempted elevation in adduction?
Dr. G.Vicente
4
In honor of Valentines day
  • To understand Browns syndrome
  • You have to understand relationships.
  • Particularly the relationship between the
    superior and inferior oblique.

5
Normal superior and inferior oblique relationship
from primary
Dr. G.Vicente
6
Normal superior and inferior oblique relationship
in adduction
Dr. G.Vicente
7
Brown Syndrome OS (from above)
Dr. G.Vicente
8
Brown 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)

9
Brown Syndrome Tx SO tenotomy(for the less shy)
SR
SR
MR
LR
LR
RM
IR
IR
IO
IO
Dr. G.Vicente
10
For those surgeons who are a little too chicken
to completely cut the SO tendon and cause a SO
palsyChicken suture technique
11
Brown Syndrome Tx Chicken suture
Dr. G.Vicente
12
For those surgeons with a sense of humorTry the
rubber chicken trickaka silicone expander
13
Brown Syndrome Tx Silicone expander
Dr. G.Vicente
14
Brown 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
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