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How to diagnose and recognize vertical deviations

Brown Syndrome. Aka oblique tendon sheath syndromeNamed by Brown 1950.Deficiency of elevation in adduction Divergence in upgazeDown shoot in attempted elev. in adduct. (different than IO palsy)Click felt on trochlea in some acquired casesOften seen with chin up position2/3 are mild and do not require treatment if ortho in primary.

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How to diagnose and recognize vertical deviations

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    1. How to diagnose and recognize vertical deviations Part III Brown Syndrome G. Vike Vicente, MD Eye Doctors of Washington

    2. Brown Syndrome Aka oblique tendon sheath syndrome Named by Brown 1950. Deficiency of elevation in adduction Divergence in upgaze Down shoot in attempted elev. in adduct. (different than IO palsy) Click felt on trochlea in some acquired cases Often seen with chin up position 2/3 are mild and do not require treatment if ortho in primary

    3. Brown syndrome OS

    4. In honor of Valentine’s day To understand Brown’s syndrome You have to understand relationships. Particularly the relationship between the superior and inferior oblique.

    5. Normal superior and inferior oblique relationship from primary

    6. Normal superior and inferior oblique relationship in adduction

    7. Brown Syndrome OS (from above)

    8. Brown Syndrome Treatment If associated with other disease ie rheumatoid arthritis or sinusitis Treat the underlying condition. Surgery if: Hypotropia in primary Anomalous head posture: severe chin up. Consider SO tendon tenotomy, SO tendon silicone expander SO tendon chicken suture (mercilene, nonabsorbable)

    9. Brown Syndrome Tx: SO tenotomy (for the less shy)

    10. For those surgeons who are a little too chicken to completely cut the SO tendon and cause a SO palsy… Chicken suture technique

    11. Brown Syndrome Tx: Chicken suture

    12. For those surgeons with a sense of humor… Try the rubber chicken trick aka silicone expander

    13. Brown Syndrome Tx: Silicone expander

    14. Brown syndrome OS

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