Brown Syndrome

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  • Mechanical restriction of the superior oblique muscle
  • Mostly congenital: idiopathic, the movement of the superior oblique tendon is hindered by the trochlea, may result in a ‘clicking’ sound or sensation
  • Occasionally acquired: trauma to the trochlea or oblique tendon, tendon inflammation (rheumatoid arthritis, pansinusitis, scleritis)
  • unilateral in 90% of cases


  • Orbital pain and pain with eye movement
  • Double vision


  • Limited elevation in adduction
  • Restricted Forced Duction Test
  • Normal elevation in abduction
  • Trochlear pathology with clicking
  • Head tilt with rotation to the healthy side
  • Hypotropia in primary position in severe cases


  • Wait-and-see approach: Spontaneous improvement in up to 75% of cases
  • Steroids and NSAIDs
  • Surgery: If head tilt, hypotropia in primary position, pronounced double vision, and pain


  • EyeWiki Brown Syndrome
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)