Brown’s Syndrome

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What is this information about?

This information is about Brown’s Syndrome, which can affect children or adults. It explains what Brown’s Syndrome is, and how it can affect someone’s daily life. It also describes different treatment options for someone with Brown’s Syndrome, if the orthoptist (specialist eye doctor) thinks it is needed.  

What is Brown’s Syndrome?

If someone has Brown’s Syndrome, they cannot move their eye, or eyes, upwards and inward (towards their nose).    

Brown’s Syndrome is usually something that you are born with. It is usually caused by a tight muscle tendon or abnormality (something not quite right), which does not allow the muscle to stretch fully. 

You can sometimes get it as an adult. This can be because of trauma, surgery or other inflammatory conditions such as Rheumatoid Arthritis.   

It is also known as superior oblique tendon sheath syndrome.   

The condition usually affects only one eye but in around 10% of cases will affect both eyes.  

What problems can Brown’s Syndrome cause?

Most people with Brown’s syndrome have no problems as the eyes are usually ‘straight’ and work together well when looking straight ahead.  

Some people may experience pain, discomfort or a ‘clicking’ sensation when they try to move their affected eye into the ‘up’ and ‘in’ (towards the nose) position. They may also notice some double vision when they do this. 

Sometimes people use a “head posture” (tilting their head) to stop these symptoms.  

The most common head posture is to raise their chin slightly and use their eyes in a slightly downward position. A head posture should be allowed, as this is the most comfortable way for your child to use their eyes together. It also supports better vision (eyesight) development.

Do people with Brown’s Syndrome need glasses?

There is no evidence to suggest that people with Brown’s syndrome are any more likely to need glasses than the rest of the population. But we may suggest your child has a glasses test routinely.

Why do we need to keep seeing the Orthoptist?

It is important for children to see the orthoptist regularly to make sure that their vision develops normally and equally, and that there are no problems with the development of their 3D vision. 

The orthoptist will guide you as to how often you will need to attend. 

What treatment is available?

Most people with Brown’s syndrome do not require any treatment.  

Children will be monitored by an orthoptist to ensure the vision develops equally in both eyes. 

If there is reduced vision in one eye (known as amblyopia), the orthoptist will recommend treatment. This treatment may include putting a patch on, or eye drops into, the ‘good’ eye. This means that the vision gets better in the weaker eye. 

Special lenses built into glasses, called prisms, can help to improve double vision when looking straight ahead.   

We do not usually suggest surgery for Brown’s Syndrome as the results are hard to predict and disappointing. 

Many children with Brown’s syndrome show signs of improvement in their eye movements as they grow older. If the condition carries on, it rarely causes problems in adult life because we spend very little of our time looking upwards and this is where problems are most likely to occur.   

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