Brown Syndrome

What is Brown syndrome?

Brown syndrome is a mechanical problem with the tendon that attaches to the outside of your eyeball. It is called the superior oblique muscle tendon. In Brown syndrome, this tendon cannot move freely. This limits your eye’s normal movements.

The superior oblique muscle tendon attaches to a small eye muscle that is responsible for pulling your eye toward the midline, pulling your eye to look downward, and rotating your eye. The superior oblique muscle tendon moves through a ring of tissue that surrounds it. This is called the tendon sheath.

Various things can limit the normal movement of the muscle tendon through the tendon sheath. When that happens, Brown syndrome results.

Brown syndrome is a rare eye disorder. The condition is usually present at birth (congenital). Sometimes Brown syndrome may be acquired later in life. Acquired Brown syndrome may be related to another health condition. It affects females slightly more often than males.

What causes Brown syndrome?

Abnormalities of the superior oblique muscle tendon or its sheath can cause symptoms of Brown syndrome. The muscle tendon or its sheath might be abnormally short or thick from birth. Some cases of Brown syndrome might be partly due to abnormalities in the genetic information passed from parents to children. Researchers are not yet clear what genes might be involved. Most children born with Brown syndrome have no family history of the disease.

Other medical conditions can cause Brown syndrome later in life as well, though this is a very rare complication. The conditions may abnormally shorten, thicken, inflame, or scar the superior oblique muscle tendon or its sheath. Known medical conditions that can cause Brown syndrome include:

• Injury
• Inflammatory disease (like lupus or rheumatoid arthritis)
• Complication from eye surgery
• Scleritis (inflammation of the white part of the eye)
• Sinus infection

Sometimes, you can get Brown syndrome later in life for unknown reasons.

Who is at risk for Brown syndrome?

At least some cases of Brown syndrome tend to run in families. You may be at greater risk for Brown syndrome if another member of your family has it. You might also be at greater risk for Brown syndrome if you have any medical conditions that can cause it, like lupus. Prompt treatment of your medical condition may help reduce your risk of getting Brown syndrome.

What are the symptoms of Brown syndrome?

Most of the time, Brown syndrome affects only one eye. However, in a few people, both eyes are affected. The symptoms can vary in severity.

Brown syndrome limits the normal movements of your eye. For example,

• If Brown syndrome affects your child’s right eye, he or she may not be able to look up with the right eye when his or her eyes are looking to the left. It may cause discomfort when your child tries to make this eye movement.
• If Brown syndrome affects your child’s left eye, he or she may not be able to look up with the left eye when his or her eyes are looking to the right. The eyes might look normal when looking toward the midline or straight ahead. The affected eye might be slightly lower than the other eye.

Other symptoms of Brown syndrome include:

• Double vision
• Eyes not in alignment with each other (strabismus)
• Droopy eyelid (ptosis)
• Chin-up and head-in tilted position (helps affected individual focus using both eyes)

If these problems are present from birth, they are often constant, though they might improve gradually. If you get Brown syndrome later in life, these symptoms might only be temporary.

How is Brown syndrome diagnosed?

Diagnosis begins with a medical history and physical exam. This includes a thorough eye exam. Medical professionals can find it challenging to diagnose Brown syndrome in young children, because they cannot respond to instructions of a normal eye exam. You may need the help of an experienced eye healthcare provider to make the diagnosis.

In addition to giving you a standard eye exam, your eye care professional might order imaging tests to get more information about the superior oblique muscle tendon.

How is Brown syndrome treated?

Your baby’s healthcare provider will figure out the best treatment for your baby based on:

• How old your child is
• His or her overall health and past health
• How sick he or she is
• How well your child can handle specific medicines, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Treatment of Brown syndrome may vary, based on the severity of symptoms and their cause.

If your child has only mild symptoms from Brown syndrome, he or she may not need any treatment right away. Alignment of the eyes may improve with age.

More severe cases of Brown syndrome may need surgery. Your child may be more likely to need surgery if his or her eyes are out of alignment when looking straight ahead. Your child might also be more likely to need surgery if he or she has double vision, or if the head position is very abnormal. During this surgery, the surgeon may cut the superior oblique muscle tendon and use a device to lengthen it. This may allow the muscle tendon to move normally. The surgery is usually successful, but some children need repeat surgery.

Brown syndrome due to other conditions is more likely to go away without the need for surgery. Treatment of the underlying medical condition may help reduce symptoms. For example, someone with Brown syndrome due to lupus might benefit from treatment with corticosteroids.

When should I call my healthcare provider?

If your child has Brown syndrome, monitor his or her symptoms closely. Your child will need close follow-up care. If symptoms worsen, plan to see your healthcare provider soon. Your child might need surgery.

Key points about Brown syndrome

Brown syndrome is a rare mechanical problem with the superior oblique muscle tendon on the outside of the eyeball. In Brown syndrome, this tendon cannot move freely. This limits the eye’s normal movements.

• Most commonly, Brown syndrome is present from birth.
• Less commonly, Brown syndrome results from other health conditions, like injury, inflammation, or infection.
• If your child has Brown syndrome, he or she may have trouble looking to the opposite side, and upward, with the affected eye.
• If your child has Brown syndrome, your healthcare provider might want to wait to see if it goes away. Some children will need surgery to correct Brown syndrome.
• If you get Brown syndrome later in life, you will probably not need surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.