Brown's syndrome

Brown's syndrome is due to fibrous adhesions in the upper medial quadrant of the orbit. These lesions involve the superior oblique tendon and trochlea and mechanically limit eye elevation. Limitation of elevation is most marked in the adducted position, and elevation improvement occurs gradually as the eye is  abducted. Differential diagnosis is concerned mainly with paresis of the inferior oblique muscle. Forced duction testing is diagnostic, since there is an upward restriction to elevation in adduction when Brown's syndrome is present. The condition is usually unilateral and idiopathic, though rarely it may be due to trauma or inflammation.

Treatment
Surgical treatment is limited to cases where an abnormal head position is present to compensate for the limitations of the involved eye. The objective is to free the mechanical adhesions and weaken the superior oblique muscle. Normalization of the head position may occur, but restoration of full motility is seldom achieved.