• Reference Number: HEY1145/2023
• Departments: Ophthalmology Department, Orthoptic
• Last Updated: 31 December 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is Brown’s Syndrome?

There are six muscles around each eye which allow the eyes to move in different directions. Brown’s Syndrome is a condition where one of the muscles that lifts the eye upwards (superior oblique muscle) does not work as it should.

The superior oblique passes through a ring of cartilage called the Trochlea. This acts as a natural “pulley” system to help the eye to move. In Brown’s Syndrome, there is a defect at the site of the pulley-trochlea complex which does not allow the muscle to pass through freely. This results in an inability to look upwards and inwards as shown in the picture below. This can give the impression of a squint when looking up and into the corner. It usually only affects one eye, but can occur in both eyes. Some patients notice a “click” or “clicking” sensation when they try to look upwards and inwards.

What is the cause of Brown’s Syndrome?

Brown’s Syndrome is usually present from birth. It may be caused by the muscle being too short, inelastic, thick, a swelling on the muscle tendon, or a ‘miss-wiring’ of the muscle fibres themselves. Most cases occur without any family history.

It is possible for Brown`s Syndrome to be acquired in later life, however this is usually as a result of surgery, injury, or inflammation in the area between the eye and the nose. 

Can this impact vision and why do I need to attend appointments?

Brown’s Syndrome does not affect the vision directly, and in most cases individuals will use both eyes together normally. Individuals with the condition may find it uncomfortable to look up into the area which is affected. In some cases an individual with Brown’s Syndrome may adopt a very subtle head posture to make it more comfortable. Any head posture should not be discouraged. In some cases there may be an associated squint or need for glasses.

In children it is advisable to attend orthoptic appointments so that your Orthoptist can ensure that the vision is continuing to develop normally. Your Orthoptist may also be able to suggest any adjustments that may make some things easier for you/your child.

Can there be any complications or risks?

Brown’s Syndrome tends to improve over time therefore children who are born with the condition do not require treatment unless there is an associated squint or a need to wear glasses. Surgery may be considered if the squint is large and/or the head posture used to compensate is large and/or uncomfortable. This would only be in marked cases and would need to be discussed with your Paediatric Ophthalmologist (children’s eye doctor).

In adults who develop Brown’s Syndrome with symptoms of double vision (diplopia), a plastic prism may help relieve symptoms by joining the two images together. A temporary prism may be fitted onto your glasses initially but can later be incorporated into them if required. In some rare cases surgery may be considered, again this would need to be discussed with your Ophthalmologist.

How can I help if my child has Brown’s Syndrome?

Looking up can be difficult for those with Brown’s Syndrome. This can be particularly difficult for children as the world is set up for adult height. As children grow taller this naturally becomes less of a problem.

In a classroom setting, sitting on the floor for story time or to look at the whiteboard can force the child to look up. This may cause discomfort and make it difficult for them to pay attention. Your child will be more comfortable when sitting at eye level with the teacher.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Orthoptic Department on tel: 01482 816605

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.