Brown Syndrome: Causes, Symptoms & Treatment

Brown syndrome occurs very rarely, but it is a rather severe condition. It affects the eye. Brown syndrome enormously reduces vision, which is why affected people often lose quality of life.

What is Brown syndrome?

Brown syndrome is named after Harold Whaley Brown, the ophthalmologist of the same name who discovered this symptom. It is also known as oblique superior tendon sheath syndrome. Brown syndrome involves an abnormality in the form of a pathological thickening of the superior oblique eye muscle (Musculus obliquus superior), which severely restricts the movements of the eye. As a result, the affected person is no longer able to consciously lower, roll or turn the eye outward by himself. This results in a kind of strabismus. Thus, Brown’s symptom belongs to the field of strabismus. Brown syndrome can occur in a wide range of age groups. Parents often notice the symptoms in young children, but in many cases Brown’s syndrome is not recognized due to its rarity, which makes treatment much more difficult. It is therefore all the more important for treating ophthalmologists to have a precise knowledge of the causes and symptoms.

Causes

Due to the characteristic thickening of the superior oblique eye muscle, the affected person can no longer control the eye entirely. The thickening prevents the tendon from moving smoothly through the cartilage sheath (trochlea) in the eye socket. This triggers the symptoms and leads to the typical strabismus. Basically, the causes of Brown syndrome have been divided into two categories: congenital and acquired. Today, however, ophthalmologists believe that Brown syndrome is a disease of the eyes that is triggered, that is, it is not congenital. Genetic causes can thus be largely excluded. Only in very rare cases is Brown syndrome recognized as a congenital disorder. In some cases, Brown syndrome is caused by allergic reactions, but rheumatic diseases can also lead to the thickening of the affected eye muscle. Ocular strain or falls and accidents are also possible causes. In addition, special operations on the eye as well as inflammation can trigger the syndrome, but this cause is also not very common.

Symptoms, complaints, and signs

Symptoms and complaints vary enormously in Brown syndrome. While some individuals are hardly restricted in their daily life and quality of life, others suffer severely from the symptoms. In some cases, for example, it is not even possible for affected individuals to obtain a driver’s license. Basically, the thickening of the tendon and the resulting restriction of eye movement causes strabismus, which is the technical term for strabismus. Affected persons see double images, mostly in the middle and upper part of the field of vision, in the lower field of vision this occurs less frequently. Normal looking straight ahead is therefore hardly possible. Many affected people then hold their head at an angle – this avoids the double images, but in the long term it also causes posture problems. The strabismus and impaired vision are often accompanied by a certain disorientation. In some cases, Brown syndrome is also associated with pain when the eye is moved. Early signs may be noticeable in younger children, especially when reading, if the child can’t read properly or holds his or her head at an angle while doing so.

Diagnosis and progression

In many cases, it takes a long time for a correct diagnosis to be made when Brown syndrome is present. Especially in children, it is difficult to distinguish Brown syndrome from classic strabismus. Adults may also suffer from symptoms for a long time before the correct diagnosis is made. Diagnosis of Brown syndrome is complicated by the fact that it is not uncommon for symptoms to appear seemingly at random, subside for some time – up to a few months – and then reappear seemingly out of nowhere. In principle, adults should consult a doctor if they see double vision or can no longer move one eye properly. Then it can be determined whether Brown syndrome is present and what causes it.

When should you see a doctor?

Brown syndrome is considered an acquired condition in most cases.As with any accident involving particularly sensitive parts of the body such as the eye, a thorough check-up by the doctor should be carried out. But chronic diseases also favor the development. These include inflammatory reactions as in rheumatism or strong allergies. Caution is advisable if this physical preload already exists and occurs in combination with the symptoms of Brownn syndrome. Although in many cases a change announces itself over a longer period of time, even short periods of illness can indicate a thickening of the tendon on the eye. Often, due to the seemingly arbitrary nature of the disease, symptoms are misinterpreted and initially lead to misdiagnosis. There is also a risk of confusion due to classic strabismus, especially in childhood. Children and adults unconsciously try to compensate for the double images located in the upper field of vision by tilting the head. Habitual misalignment, headaches and problems with orientation should always be clarified by a visit to the doctor. The additional sensation of pain caused by the thickening of the tendon in the eye socket during eye movement is considered rather untypical for common strabismus. This disease does not represent an acute emergency and the measures for therapy fall out according to the severity of the symptomatology.

Treatment and therapy

The proper treatment of Brown syndrome also depends on its severity. If the symptoms are hardly noticeable for the affected person and no restriction in everyday life occurs, therapy is often not necessary. For milder conditions, cortisone is often injected. In many cases, ibuprofen has also proven to be an active ingredient. Only in very severe cases, in which normal everyday life can hardly be managed, should surgical intervention be considered: This involves mechanically thinning the thickened tendon of the eye muscle by stretching it with silicone. Corticosteroids are also often used. These are injected directly into the trochlea.

Outlook and prognosis

Brown syndrome is itself a relatively severe limitation in the life and daily activities of the affected individual. It cannot be completely treated, although the affected person’s life expectancy is also not negatively limited by this condition. The symptoms and complaints can vary greatly in this syndrome. In some patients there are almost no symptoms, so that the visual acuity is reduced only very little by the Brown syndrome. In this case, no special treatment is usually necessary. In severe cases, the symptoms can be alleviated with cortisone. An operation can also be performed to improve the quality of life of the patient. However, this does not provide complete relief of the symptoms. If there is no treatment for Brown syndrome, there is no improvement. However, the symptoms usually do not worsen. Early treatment of this syndrome has a very positive effect on the further course of the disease and can prevent various complications. Often, Brown syndrome also leads to psychological discomfort or depression, so the affected person is also dependent on psychological treatment.

Prevention

Unfortunately, there is hardly any way to prevent Brown syndrome. To avoid the common disease rheumatism as a cause, attention should be paid to a sufficient amount of physical activity and a balanced diet. Varied food in childhood prevents allergies and allergic reactions of children. In principle, however, it is advisable to consult an ophthalmologist as soon as possible if problems arise, who can examine the eyes and make a diagnosis.

Aftercare

Brown syndrome is a disease of the eye that can be treated surgically or by just taking it easy. Follow-up care is long-term and focuses on progress checks and regular eye exercises that can improve vision. The control examinations should take place once or twice a month at the beginning. The frequency depends on how well the wound heals after surgery. If the visual ability has been significantly improved by the operation, this already speaks for a positive course. If no complications occur, a few progress checks at intervals of one month are sufficient. Later, six-monthly examinations are sufficient.If complications or late effects occur, this can be determined during follow-up care. The necessary treatment measures can then be initiated. Regardless of whether complications occur, eye exercises must be performed as part of the follow-up care. The patient should start the eye training under the supervision of an expert and can later continue it independently. Specific training of the affected eye muscle can increase the resilience of the eye. If Brown’s syndrome occurs as a result of ocular strain, no follow-up care is usually necessary. After drug treatment, the eye recovers on its own within a few days.

What you can do yourself

Depending on its severity, a number of treatment measures may be considered for Brown syndrome. Conservative therapy can be supported by a number of self-help measures. First of all, general things such as a healthy lifestyle with a balanced diet, regular exercise, and abstaining from alcohol, nicotine, etc. are recommended. Although an active and healthy life cannot directly improve vision, it can improve the often degraded quality of life. In addition, avoiding harmful influences helps to preserve the remaining vision. Sports activities such as weight training, yoga or Pilates also counteract the disorientation that is typical of Brown’s syndrome. In addition, various natural remedies help to strengthen vision. Eyebright, for example, is said to have a soothing effect on tired and overstimulated eyes. Celandine helps with various eye problems and the medicinal plant calamus soothes the edges of the eyelids. If the effects of Brown syndrome (e.g., strabismus, conspicuous visual aids) lead to psychological discomfort, concomitant therapy may also be considered. Various physicians and specialty clinics can provide further information on managing the condition.