The most striking feature of Brown’s syndrome is restricted upward movement of the affected eye when the eye is looking inwards. This is particularly obvious in smaller children when they try to look upwards at their parents.

• The vast majority of children with Brown’s Syndrome do not have a strabismus when they are looking straight ahead, but occasionally in severe cases the eye can be lower than the other eye, This is known as a hypotropia. These children will often adopt a slightly chin up head posture to compensate for this strabismus.
• In some cases of Brown’s syndrome, the affected eye shoots downwards when it looks inwards.

The vast majority of children with Brown's syndrome develop good vision in both eyes and good stereopsis. Surgery is required only if there is a significant strabismus in the straight ahead position or if the upward movement of the eye is a very restricted.

The aim of surgery is to weaken the superior oblique muscle. This can be done either by lengthening the tendon by inserting a length of silicone into the tendon, or by moving the insertion point of the muscle.

Republished, with permission, from www.squintclinic.com.