How to diagnose and recognize vertical deviations

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How to diagnose and recognize vertical deviations

• Part III
• Brown Syndrome
• G. Vike Vicente, MD
• Eye Doctors of Washington

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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

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Brown syndrome OS
Divergence in upgaze
Down shoot in attempted elevation in adduction?
Dr. G.Vicente
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In honor of Valentines day

• To understand Browns syndrome
• You have to understand relationships.
• Particularly the relationship between the
  superior and inferior oblique.

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

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