Session: Free papers Session VI - Vertical Strabismus

Clinical Evolution of Congenital Brown’s Syndrome

Introduction:  Brown’s syndrome is characterized by a limitation of elevation in adduction with positive force duction testing. Surgery is usually reserved for severe cases. The aim of this study is to evaluate the clinical progression and outcome of patients followed with conservative approach.

 

Methods: The medical records of consecutive patients diagnosed as congenital Brown’s syndrome between 2007-2023 and followed conservatively were reviewed. Deviation in primary position (PP), grade of limitation of elevation in adduction, head posture, presence of V pattern, anisometropia and macular torsion were main outcome measures. Abnormal head posture was measured by goniometer. Fundus torsion was evaluated by macular optical coherence tomography imaging performed at the last visit.

 

Results : A total of 26 patients were identified (16 female and 10 male patients) with an age range at referral of 8 months to 11 years (mean 51+/- 31.4 months), mean follow-up period was 43,5 months. Three patients had bilateral Brown’s syndrome and right eye was effected in 11 patients. Sixteen patients were orthotropic in PP, stereopsis was present in 23 patients. Compensatory head position was present in 8 patients, 5 with chin elevation 8 to 10 degrees, 3 patients had contralateral face turn 8 to10 degrees.  One patient had total improvement from a -4 limitation in 6 years follow up , 1 patient with bilateral -4 limitation had asymmetrical improvement inducing hypertropia at the resolved side.  Orbital magnetic resonance imaging was performed in 10 patients; 1 patient displayed superior oblique muscle belly atrophy (4.2 mm2 versus 5.8 mm2 at the normal side ) and 1 patient revealed tendon-trochlear complex enlargement and contrast enhancement.

 

Conclusions: Conservative approach seems to be adequate in most congenital Brown’s syndrome cases.  Spontaneous resolution of congenital Brown’s syndrome should always be considered before planning surgical treatment.