Brown Syndrome

What is Brown syndrome?

Brown syndrome is an issue with the muscle or tendon that controls your eyes’ movements (your superior oblique muscle and tendon). You might see it referred to as superior oblique tendon sheath syndrome.

Some people are born with unusually short or tight superior obliques and have Brown syndrome from birth. If something causes your superior oblique muscle or tendon to swell or thicken you can develop Brown syndrome later in life.

Brown syndrome usually only affects one eye (it occurs unilaterally). It makes it hard or impossible to move your eye freely in all directions. It’s usually hard for people with Brown syndrome to look in and up at the same time. Brown syndrome can also affect how far up your eye can move.

If you have Brown syndrome in one of your eyes, you’ll still be able to see out of it, but it won’t move freely as you look in other directions. It might feel like your eye is “stuck” or can’t quite move all the ways it usually can.

Brown syndrome can sometimes be treated with medication. Some people eventually need surgery.

Visit your healthcare provider or eye care specialist as soon as you notice any changes in your eyes or vision.

Who is affected by Brown syndrome?

Brown syndrome is rare, but it can affect anyone. It’s slightly more common in women and people assigned female at birth.

What are the symptoms of Brown syndrome?

Symptoms of Brown syndrome include:

• Trouble looking in and up (toward your nose).
• Eyes that don’t line up.
• Eye pain.
• A “click” or “popping” noise or feeling when you move one of your eyes.
• Ptosis (droopy eyelid).

People with Brown syndrome sometimes tilt their head without realizing they’re doing it. This is usually an unconscious (unintentional) reaction to their eye not moving freely.

Brown syndrome can affect your vision too, especially when you’re not looking straight ahead. Brown syndrome can cause:

• Decreased sight.
• Double vision (diplopia).
• Decreased depth perception.

What causes Brown syndrome?

Brown syndrome happens when something affects the muscles and tendons that control your eyes. The most common causes of Brown syndrome include:

Congenital Brown syndrome

Congenital Brown syndrome is present in a baby’s eye when they’re born. It’s the most common type of Brown syndrome. Experts aren’t sure what causes congenital Brown syndrome.

Autoimmune diseases

An autoimmune disease is the result of your immune system accidentally attacking your body instead of protecting it. It's unclear why your immune system does this. Autoimmune diseases that cause Brown syndrome include:

• Lupus.
• Rheumatoid arthritis.
• Sjögren’s syndrome.
• Thyroid eye disease or dysthyroid disease.

Infections and other eye conditions

Infections and other issues with your eyes that cause inflammation can lead to Brown syndrome. Some of the most common conditions include:

• Sinus infections (sinusitis).
• Orbital cellulitis.
• Trochleitis.
• Tenosynovitis in superior oblique.

Trauma

Brown syndrome can be caused by traumas that damage your face and eyes, including:

• Eye injuries.
• Facial fractures.
• Complications after eye surgery.

How is Brown syndrome diagnosed?

Your provider or eye care specialist will diagnose Brown syndrome with an eye exam. They’ll look at your eye as it moves and while you’re looking straight ahead. They’ll also look inside your eye to rule out other issues that could be affecting it and causing your symptoms.

How is Brown syndrome treated?

Treatment for Brown syndrome depends on what’s causing it and how severe your symptoms are.

Treating congenital Brown syndrome

Children born with congenital Brown syndrome sometimes grow out of it without any treatment. If your child has Brown syndrome, your eye care specialist will tell you how often they need eye exams to monitor any changes in their eye.

Treating inflammatory Brown syndrome

If inflammation around your eye from an autoimmune disease, infection or trauma is causing your symptoms, treating that cause will usually treat the symptoms of Brown syndrome too.

Your provider will tell you which treatments you need based on what’s causing the inflammation.

You’ll probably need medication to help reduce the inflammation in your superior oblique. The most common medications used to treat Brown syndrome are:

• NSAIDs: Over-the-counter NSAIDs like aspirin, ibuprofen and naproxen relieve pain and reduce inflammation. Talk to your provider before using NSAIDs for more than 10 days in a row.
• Corticosteroids: Your provider might inject a corticosteroid directly into your superior oblique.
• Immunosuppressants: Your provider might prescribe an immunosuppressant to stop your immune system from damaging healthy cells and tissues.

Brown syndrome surgery

Most people with Brown syndrome don’t need surgery. But if Brown syndrome is severely impacting your vision — or your symptoms don’t get better after other treatments — your provider might recommend surgically repairing your superior oblique.

Your surgeon will tell you what to expect and which technique they’ll use based on what’s causing the Brown syndrome, including:

• Tenotomy or tenectomy to loosen your superior oblique if it’s too tight.
• Expanding your superior oblique if it’s too short.
• Removing a cyst if that’s what’s causing your symptoms.

How can I prevent Brown syndrome?

Because it’s caused at birth or by conditions and situations you can’t control, you can’t prevent Brown syndrome.

In general, make sure you always wear protective eyewear and proper safety equipment while working with tools or doing any activity that could injure your eyes.

When should I have my eyes examined?

Having your eyes and vision checked regularly can help your eye care specialist identify problems right away. How often you should get your eyes checked usually depends on your age:

• Kids: A pediatrician will check your child’s eyes during well visits — especially around the time they learn the alphabet and then every one to two years.
• Adults under 40: Every five to 10 years.
• Adults between 40 and 54: Every two to four years.
• Adults older than 55: Every one to three years.

You might need your eyes checked more often than this if you wear glasses, contacts or need another type of visual aid. People with diabetes need their eyes checked more often than what’s listed here.

Ask your eye care specialist how often you need an eye exam.

What can I expect if I have Brown syndrome?

Your symptoms should get better once you treat what’s causing Brown syndrome. You should expect to make a full recovery.

Some children born with Brown syndrome grow out of it without treatment as they get older.

Even if you need surgery, Brown syndrome shouldn’t have any long-term impacts on your eyes or vision.

When should I see my healthcare provider?

See your healthcare provider as soon as you notice any changes in your eyes or vision.

Go to the emergency room if you have any of the following symptoms:

• A sudden loss of vision.
• Severe eye pain.
• You see new flashes or floaters in your eyes.

What questions should I ask my doctor?

• Do I have Brown syndrome or another type of strabismus?
• How long will my symptoms last?
• Will I need any treatment?
• What caused Brown syndrome?
• How often do I need follow up eye exams?

What’s the difference between Brown syndrome and lazy eye (amblyopia)?

Brown syndrome and lazy eye (amblyopia) are conditions that usually affect one eye. The difference is what’s actually happening to your eye or vision.

Brown syndrome happens when something is wrong with the muscle or tendon that controls your eyes’ movements. It makes it hard or impossible to move your eye in every direction. It can affect your ability to see, but there’s nothing wrong with your eye itself.

Amblyopia develops during childhood. If your child has amblyopia, their brain learns to ignore the image from their misaligned or blurry eye. Instead, their brain will only rely on their stronger eye, allowing vision in their weaker eye to get worse.

Kids born with Brown syndrome can sometimes develop amblyopia. Talk to your provider or eye care specialist as soon as you notice any changes in your child’s eyes.

What’s the difference between Brown syndrome and strabismus (crossed eyes)?

Strabismus is a condition in which your eyes don’t line up with one another. In other words, one eye is turned in a direction that's different from the other eye.

Brown syndrome is a form of strabismus. This will be most noticeable when you look in or up. One of your eyes won’t move as much (or at all) as the other.

Depending on how much your eye muscles and tendons are affected, your eyes might be slightly out of alignment if you’re looking straight ahead too.

A note from Cleveland Clinic

It can be scary to notice something physically stopping your eye from moving or to learn that your baby was born with a congenital issue. The good news is that no matter what causes Brown syndrome, it’s almost always a temporary issue. In fact, you or your child might not need any treatment other than a few visits to your eye care specialist.

Talk to your provider or eye care specialist right away if you notice anything different about your eyes or vision. Even small changes can be the first sign of issues that need treated as soon as possible.