Brown's syndrome

Left Brown's syndrome. 

The main feature is the failure of elevation in the adducted eye. 

Additional features:

  • in the primary position, the affected eye may be hypotropic
  • there may be an abnormal head posture with the head tilt to the affected side, a face 

  • turn to the normal side and chin elevation.
  • there may be slight downshoot of the affected on adduction because of the mechanical effect of 

  • a tight superior oblique tendon that cannot relax on adduction. 
  • widening of the palpebral fissure on adduction and a V pattern
  • the condition is bilateral in 10% of cases
  • the elevation may improve on repeated testing.


1. How do you confirm the diagnosis of Brown's syndrome and what is its differential diagnosis?

2. What are the causes of Brown's syndrome?

3. How would you advise a mother with regard to her child with an unilateral congenital Brown's syndrome?

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