Indian Journal of Ophthalmology

: 1982  |  Volume : 30  |  Issue : 1  |  Page : 57--59

Brown's syndrome associated with congenital ptosis

Vasudev Anand Rao, GC Sood, Santosh Kumar 
 Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research Pondicherry, India

Correspondence Address:
Vasudev Anand Rao
JIPMER, Pondicherry 605 006

How to cite this article:
Rao VA, Sood G C, Kumar S. Brown's syndrome associated with congenital ptosis.Indian J Ophthalmol 1982;30:57-59

How to cite this URL:
Rao VA, Sood G C, Kumar S. Brown's syndrome associated with congenital ptosis. Indian J Ophthalmol [serial online] 1982 [cited 2023 Mar 22 ];30:57-59
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Full Text

Brown's syndrome or superior oblique ten­don sheath first described by Brown[1] in 1950 is rare[2],[3] It has the following features-apparent complete paralysis of the inferior oblique, no secondary contracture of the direct antagonist namely the homolateral superior oblique; down-drift of the affected eye on abduction, normal movements of the affected eye on abduction; the palpebral fissure on the affec­ted side widens when the affected eye is abduc­ted and limitation of movement of the affected eye on forced duction test in the field of action of the inferior oblique muscle.

The purpose of the present paper is to report a case of this syndrome which was bilateral and associated with ptosis and tele­canthus.


A 20 year old male patient came to JIPMER Eye OPD with complaint of droop­ing of upper lid both eyes and squinting alter­natively outwards both eyes since birth.

Local examination revealed bilateral ptosis and telecanthus. There was an alternate divergent squint of 15°. The action of right and left inferior oblique was deficient in laevo and dextro elevation respectively. There was depression of the abducted eye on dextro and laevo version. Movements were full in dextro and laevo depression. The widening of the palpebral fissure could not be shown due to the associated ptosis.

Visual acuity in right eye with


binocular vision with Worth's 4 dot test or on the synoptophore.

Under general anaesthesia there was limi­tation of movement in both eyes on forced duction test in the field of action of the infe­rior oblique muscle.


Brown[1] attributed the syndrome to a con­genitally short sheath of the superior oblique which is firmly attached to the trochlea. When the eye is straight or abducted the sheath is loose and allows full rotation. However, when the eye is abducted the congenitally short sheath acts as a tight band which pre­vents elevation. In 1973 Brown[4] identified 2 types true and simulated sheath syndrome. In the latter the posterior part of the superior oblique muscle and tendon are thickened due to inflammation extending from the ethmoid sinus, from orbital fractures or from frontal sinus surgery. Ours is a case of true Brown's syndrome since it was present at birth, there was no inflammatory episode, trauma or sur­gery. Goal and Gogi[2] reported a case of the syndrome which was due to sub-clinical infla­mmation in the region of the trochlea of the superior oblique. When the inflammation subsided there was marked improvement in the ocular motility.

In the present case the condition was bilateral and was associated with congenital ptosis and telecanthus. Jain and Chander[3] have also described association of congenital ptosis with this syndrome. Brown[1] reported associated coloboma of choroid in one case while Hansen6 reported congenital cardiac anomalies in 2 cases. However in our case there was no associated congenital abnorma­lity elsewhere in the body. Gupta and Hari Gopal3 have described this syndrome in 8 members of a family.

Brown[] has shown that the limitation of elevation disappears when the sheath of the superior oblique has been served. Crawford et a1[7] divided the final results following teno­tomy of the superior oblique into 3 groups. (1) Patients with partial residual Brown's syndrome who gradually improved sponta­neously over several years, (2) Patients who had minimal or moderate superior oblique muscle paresis, (3) Patients with marked superior oblique muscle paresis.


A rare case of true Brown's syndrome associated with congenital ptosis and tele­canthus is reported.


1Brown H.W. 1950, Symposium, p. 205 C.V, Mosby Co, St. Louis.
2Goel, B.S. and Gogi, R 1968, Orient Arch. Ophthalmol. 6 : 302.
3Gupta, J.S. and Gopal Hari 1969, Orient Arch. Ophthalmol. 7 : 332.
4Brown, H.W. 1973, Doc. Ophthalmol. 34: 123.
5Jain, LS. and Chander B 1963, Orient. Arch. Ophthalmol. 1 :311.
6Hansen, E 1968, Acta Ophthalmologica, 46 : 469.
7Crawford J.S. Ortan, R.B, and Daily S 1980, Amer J. Ophthalmol 89 : 824.