Brown’s syndrome

Patient Information Leaflet

Introduction

There are six muscles around each eye which help move our eyes in different directions. Brown’s syndrome affects the superior oblique muscle. Each superior oblique muscle (one on each eye) helps to move the eye up. Brown’s syndrome usually affects only one eye, but in some cases can affect both eyes.

What causes Brown’s syndrome?

Brown’s syndrome is an eye movement condition which can be congenital (present from birth) or acquired (develops later in life).

In congenital cases of Brown’s syndrome, it is not entirely understood why it occurs. There are several theories, which include the muscle may be too short or too tight, and therefore may not work properly. Another theory is that there could be a small ‘nodule’, which may restrict the movement of the muscle.

If Brown’s syndrome is acquired later in life, this could be due to various reasons. These include inflammation, swelling or scar tissue which may restrict the movement of the superior oblique muscle. Brown’s syndrome may also occur following certain types of surgery near the area of the affected muscle, for example, following squint surgery or frontal sinus surgery.  

What are the features of Brown’s syndrome?

• Restricted upward movement – this is usually more noticeable when looking up into the direction of the nose and the affected eye. This restricted upward movement is usually more noticeable in small children, as they often look up. As we grow, we tend to look up less frequently.
• Head posture – the chin may be elevated, or the head may be tilted and turned to help keep the eyes working together.
• Head movement – when looking up towards the area of restriction, the head may be moved to look up, rather than moving the eyes alone.
• Downshoots – the affected eye or eyes may be seen to ‘drift’ downwards when looking towards the nose.
• Squint – in some cases, there may be a misalignment of the eyes (squint) when the head is held in a straight-ahead position.
• Amblyopia – vision may be reduced in one eye. This may be coincidental, or due to the presence of a squint.

What are the symptoms of Brown’s syndrome?

• discomfort looking up
• some patients may describe a ‘click’ or ‘clicking’ sensation when looking up
• double vision may be experienced when looking up. In acquired cases, double vision may also be experienced where there is a squint in the straight-ahead position.
• some patients may experience neck pain if there is a significant head posture which is used to help keep the eyes working together.

What is the treatment for Brown’s syndrome?

Observation – children with Brown’s syndrome are usually monitored in the Orthoptic Department for a period of time to ensure their vision develops normally. Children with Brown’s syndrome usually have good vision. With time, Brown’s syndrome may become less noticeable if a patient grows taller and therefore does not look upwards as often. In some patients, there may be spontaneous improvement in their eye movements looking up.

Glasses – glasses may be required if there is a coincidental focusing error. The need for glasses is not associated with Brown’s syndrome.

Amblyopia treatment – occlusion therapy (patching / atropine eye drops) may be needed if vision is weaker in one eye. (If indicated, your orthoptist will discuss this).

Surgery – surgery is rarely done for patients with Brown’s syndrome. Surgery may be required if there is a significant squint in the straight-ahead position or if there is a head posture which causes discomfort. (If indicated, your orthoptist and/or doctor will discuss this).

What if I have any problems or questions after reading this leaflet?

Please contact the Orthoptic Department at Russells Hall Hospital on

01384 456111 ext. 3636 (9am to 4.30pm, Monday to Friday).

Eye emergency, out of hours

In case of an eye emergency after the closing hours of the Eye Clinic (including weekends and bank holidays), please contact the eye doctor on call by ringing the switchboard at:

Birmingham and Midland Eye Centre on 0121 507 4440

The doctor on call is usually based at the Eye Centre, City Hospital, Dudley Road, Birmingham. They may need to call you back, and if necessary, they will arrange for you to visit them.

Note: The information in this booklet is provided for information only. The information found is not a substitute for professional medical advice or care by a qualified doctor or other healthcare professional. Always check with your orthoptist if you have any concerns about your condition or treatment. This is only indicative and general information for the procedure. Individual experiences may vary and all the points may not apply to all patients at all times. Please discuss your individual circumstances with your orthoptist.

We are always happy to answer any questions regarding your child’s treatment. If, after reading this leaflet, you still have concerns or questions, please call the department on 01384 456111 ext. 3636.

Author: Layla Morris
Specialist orthoptist

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on 01384 456111 and ask for the relevant department who issued this leaflet.

If you have any feedback on this patient information leaflet please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

Brown’s syndrome LM/CS/ST/DP/09 2024 v2 – review 06 2027 DGH Ref:     DGH/PIL/02172