What Is Brown Syndrome?

Medically Reviewed by Poonam Sachdev on August 22, 2022
4 min read

Brown syndrome is a condition defined by the inability to move the eyes. Learn about the causes, symptoms, and possible treatments for this condition.

Brown syndrome is a condition that affects your child’s eye movements. It is usually a congenital disability seen at birth. Some occurrences of Brown syndrome may be permanent, while others may be temporary or recurring. The condition was first explained by Dr. Walter Brown, who initially called it “superior oblique tendon sheath syndrome.” However, calling this condition a syndrome may be inaccurate, as it’s limited to a specific part of the eyes.

Your eye movements are regulated by the muscles around the eye socket. The muscles that allow you to move your eyes in all directions and within the socket are called the superior oblique tendon and the trochlea, which are placed above the eyeball. The superior oblique tendon has multiple functions, such as:

  • Pulling the eyes towards the central line of vision
  • Moving the eyes to look down
  • Rotating the eyes

In this condition, the tendon’s movement is restricted by the trochlea, which limits eye movement. Brown syndrome typically affects only one eye, but it affects both eyes in roughly 10% of people diagnosed with this condition.

While most incidences of Brown syndrome are congenital, it may also occur later in life due to other health conditions. These could be injuries, inflammation, complications from eye surgery, or a sinus infection. Research shows Brown syndrome is more likely to occur in females than males.

In most cases, Brown syndrome affects only one eye, and the right eye is more likely to be involved. But there are some instances where Brown syndrome affects both the eyes. Symptoms of this condition may differ in severity and limit regular eye movements.

Symptoms of Brown syndrome in the right eye. When your child looks up to the left, they may be unable to do so using the right eye. In some cases, when your child tries to look up with the right eye, it may cause pain.

Symptoms of Brown syndrome in the left eye. When your child looks up to the right, they may not be able to look up using the left eye.

Brown syndrome can also be identified through other symptoms.

  • The eyes may be partially or completely unable to move toward the center or outward from it.
  • The affected eye may seem out of alignment with the healthy eye. This may become more obvious when the child is looking up.
  • Your child’s eyes may widen when they look upward or tilt their head backward.
  • The affected eye may seem to be looking down even when the child is looking straight ahead or upward.
  • The eyelids may look droopy.

The exact cause of congenital Brown syndrome can’t be determined in most cases. The muscle tendon or its sheath (the layer above the tendon) may be unusually short or thick right from the child’s birth. Brown syndrome could be caused by a genetic defect, although one hasn't been identified. Many children born with Brown syndrome don’t have a family history.

Although acquired Brown syndrome is rare, blunt object trauma to the eye socket may cause this condition. Surgery on the sinus, eyelid, or teeth could also cause Brown syndrome. Some diseases like rheumatoid arthritis, sinusitis, and lupus could also lead to inflammation of the trochlea-tendon structure and restrict eye movements. But the actual mechanism that limits the actions of the muscles and tendons typically varies in all these conditions.

Treatment for Brown syndrome is determined by your child’s age, symptoms, and overall health, and the causes of the condition. In many cases, eye alignment may become better with age, particularly in children whose eyes are well-aligned when looking straight ahead. Severe incidences of Brown syndrome may call for surgery. This is especially true when:

  • The eyes are not in alignment even when your child is looking straight ahead.
  • Your child has double vision.
  • They have an unusual head position when looking in certain directions.

Surgery may be done to elongate the superior oblique muscle tendon and enhance the range of eye movement. Sometimes the portion of the tendon that’s connected to the superior oblique muscle may be removed. Surgery is effective in most cases, but the condition may reappear after some time. Acquired cases of Brown syndrome can be treated by addressing the underlying condition.

This may include using corticosteroids and other drugs like ibuprofen to treat inflammatory conditions or lupus. In some cases, doctors may also recommend operating on the unaffected eye.

The eyeball looks perfectly fine, but the movement of the eyeball is limited, causing misalignment between the affected and the unaffected eye. This misalignment is most noticeable when the child is looking upward. These movements don’t cause the child any pain but could lead to double vision, which is why they may try to avoid them.

Your child may move their chin up or turn their head to help them see better in the direction where their movements are limited. It may seem like the eye that moves higher is the affected one, but it's usually the other eye.

In most cases, Brown syndrome does not get worse. Improvements in congenital conditions have been reported in roughly 75% of the cases. Acquired Brown syndrome may also get resolved without treatment.