Brown Syndrome

Brown syndrome is a condition that makes it hard to move one of your eyes up or in, toward your nose. Superior oblique tendon sheath syndrome is its medical name.

Brown syndrome usually only affects one eye at a time. You’ll still be able to see out of both eyes. But one won’t move like it should. It might feel like your eye is “stuck” or can’t quite move all the ways it usually can.

It will be especially hard to look up and in. Picture looking at something right above you without moving your head. If you have Brown syndrome, your affected eye won’t be able to move in that direction smoothly or completely.

Types of this condition

Brown syndrome is an issue with the superior oblique muscle or tendon. These work together to move your eyes. There are two types:

• Congenital: This is when you’re born with Brown syndrome. It’s the most common type. Your child may be born with unusually short or tight superior obliques.
• Acquired: This is when a health condition or injury causes Brown syndrome. Damage or inflammation can stop the superior oblique muscle and its tendon from working like they should.

Symptoms of Brown syndrome

Brown syndrome can cause several symptoms, including:

• Trouble looking in and up
• Eyes that don’t line up
• Eye pain
• Feeling or hearing a “click” or “pop” when you move one of your eyes
• A droopy eyelid

You might tilt your head without realizing it. Your body will automatically try to compensate for one of your eyes not moving. You probably won’t notice this until someone points it out.

Having Brown syndrome can affect your vision when you’re not looking straight ahead. You might notice:

• Blurry vision
• Double vision
• Decreased depth perception

What causes Brown syndrome?

Its causes depend on which type you have. Babies are born with congenital Brown syndrome. Experts aren’t sure why this happens.

Lots of issues can cause acquired Brown syndrome. Autoimmune diseases can cause long-term inflammation in your body. Other issues may be more temporary.

Autoimmune diseases happen when your immune system damages your body instead of protecting it. Some can lead to Brown syndrome, including:

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

Anything that causes inflammation can lead to Brown syndrome. Some other causes can include:

• Sinus infections
• Orbital cellulitis
• Trochleitis or tenosynovitis in your superior oblique
• Eye injuries
• Broken bones in your face
• Complications after eye surgery

How doctors diagnose this condition

An eye doctor will diagnose Brown syndrome with an eye exam. They’ll watch your eye as it moves, and while you’re looking straight ahead. They’ll also look inside your eye. This will help them rule out other issues that could be causing the symptoms.

Your provider might suggest tests to confirm specific causes, like infections. But usually, you won’t need any lab or imaging tests for them to diagnose Brown syndrome.

How is it treated?

Which treatments you’ll need will depend on what’s causing Brown syndrome.

Congenital Brown syndrome doesn’t usually need treatment. Many children grow out of it as their body develops. This usually takes a few years. Your eye doctor will tell you how often you or your child will need follow-up exams to monitor any changes.

Your eye doctor will suggest ways to reduce inflammation if you have acquired Brown syndrome. You might need:

• NSAIDs: Over-the-counter aspirin, ibuprofen and naproxen relieve pain and reduce inflammation. Talk to your provider before taking them for more than 10 days in a row.
• Corticosteroids: Your provider might inject a corticosteroid directly into your superior oblique. This will help loosen it.
• Immunosuppressants: Your provider might prescribe an immunosuppressant to stop your immune system from damaging healthy cells and tissues.
• Surgery: Your eye doctor might suggest surgery if Brown syndrome severely affects your eyes. Or if other treatments don’t work.

When should I see my healthcare provider?

Visit an eye doctor or your regular healthcare provider as soon as you notice any changes in your eyes or vision. Tell them when you first noticed the changes and how quickly the symptoms get worse.

Your eye doctor will tell you how often you or your child will need eye exams in the future.

What can I expect if I have this condition?

The symptoms should get better once you start treatment. You should expect to make a full recovery. Even if you need surgery, Brown syndrome shouldn’t have any long-term impacts on your eyes or vision.

Your provider will tell you how long it might take for your child to grow out of Brown syndrome. It varies. But they’ll let you know what to expect.