Brown Syndrome: Clinical Presentation

Abstract

The original clinical description of Brown Syndrome in 1950 was so complete that all the characteristics remain relatively unchallenged today. The classic feature is a limitation of elevation in the adducted position which resembles an inferior oblique palsy, but is resistant to voluntary ductions and forced duction testing. Other findings include a downshoot of the affected eye in adduction, V pattern exotropia in upgaze, and widening of the palpebral fissure on adduction. More severe cases may include abnormal head position, hypotropia in primary position and loss of sensory fusion. Congenital and acquired cases include similar findings, but acquired cases are more likely to resolve spontaneously or occur with discomfort in the trochlear area.