Brown Syndrome: Features and Long-term Results of Management.

OBJECTIVES: The goal of this study was to evaluate surgical techniques and outcomes in patients with Brown's syndrome. METHODS: A retrospective review was conducted of patients who underwent surgery of the superior oblique (SO) muscle between 2003 and 2011 at a referral center. RESULTS: In all, 190 patients (111 female and 79 male) with an age range of 4-50 years were included in the study. The right eye was affected in 98 patients, and the left eye in 92 patients. Abnormal head posture (AHP), ocular movement (OM), and hypotropia were assessed. The greatest improvement of AHP was seen following an SO temporal tenotomy (91%). Patients with a -4 limitation achieved full OM after a SO temporal tenotomy. CONCLUSION: Temporal tenotomy provided the best improvement in limitation of elevation in adduction.

[Brown's syndrome]. / Syndrome de Brown.

Brown's syndrome is related to an abnormality of the superior oblique muscle: it is manifested by an oculomotor disorder with active and passive limitation of elevation in adduction, the field of action of the inferior oblique muscle. The origin is congenital or acquired secondary to multiple causes - inflammatory-infectious, traumatic or iatrogenic. The clinical and paraclinical signs are suggestive. Cerebral and orbital imaging including CT and magnetic resonance imaging (MRI) is essential for the diagnosis and management of congenital or acquired Brown's syndrome. The course may yield improvement (spontaneous or after etiological treatment) or a steady state. Treatment is rarely surgical. The indication for surgery requires specific functional and clinical signs: torticollis, hypotropia in primary position, associated strabismus and impaired binocular vision; the long-term results of the various surgical techniques are variable.

Antielevation Syndrome after Unilateral Anteriorization of the Inferior Oblique Muscle

PURPOSE: To report antielevation syndrome with restriction of elevation on abduction in the operated eye and overaction (OA) of the inferior oblique muscle (IO) of the contralateral eye after unilateral IO anteriorization (AT). METHODS: Medical records were reviewed retrospectively in 8 of 24 patients who underwent unilateral IOAT. Four patients were referred from other hospitals after the same surgery. RESULTS: Four patients had infantile esotropes. The rest showed accommodative esotropia, superior oblique palsy, exotropia, and consecutive exotropia. The mean amount of hyperdeviation was 16.3 PD (10~30). The mean restriction of elevation on abduction in the operated eye was -1.6 (-1~-4) and IOOA of the contralateral eye was +2.7 (+2~+3). IOAT of nonoperated eyes in 4 patients, IO weakening procedure of anteriorized eyes in 2 patients, and IO myectomy on an eye with IOAT in 1 patient were performed. Ocular motility was improved after surgery in all patients. CONCLUSIONS: Unilateral IOAT may result in antielevation syndrome. Therefore bilateral IOAT is recommended to balance antielevation in both eyes. A meticulous caution is needed when performing unilateral IOAT.

Congenital Double Elevator Palsy in Two Brothers

Double elevator palsy (DEP) is an unusual anomaly of ocular motility in which both elevator muscles of the same eye are weak with a resultant inability or reduced ability to elevate the eye and hypotropia. This anomaly is occured congenitally, but occasionally occured as an acquired form. Congenital DEP, which is main cause of the monocular elevation paralysis, is characterized by the progressive deterioration and the absence of diplopia. The etiology is obscure, but is thought to be supranuclear lesion. We observed DEP of the same side of eyes in two patients who were brothers. The limitation of elevation and hypotropia were improved after Knapp's transposition procedure or Jensen's procedure.