Brown's tendon sheath syndrome

Brown's tendon sheath syndrome, also known as Brown syndrome, is a structural anomaly of ocular motility characterized by a short superior oblique tendon sheath [7]. This condition affects the movement of the eye, specifically limiting its normal range of motion.

The symptoms of Brown syndrome include:

• Vertical diplopia (double vision)
• Poor binocular vision/stereopsis
• Orbital pain and tenderness
• Pain with eye movement
• Abnormal head position

In some cases, a 'click' may be heard when the affected eye moves [5]. The condition can be congenital or acquired, with the latter being caused by trauma, surgery, sinus infections, or other underlying disorders such as Lupus or Rheumatoid Arthritis.

Brown syndrome can be divided into two categories:

• Congenital: present at birth, resulting from structural anomalies other than a short tendon sheath
• Acquired: caused by damage to the trochlea of the superior oblique muscle tendon, an abnormality of the superior oblique tendon itself, or abnormalities of the tissue around the rectus extraocular muscles [12]

The symptoms and causes of Brown syndrome are closely related to the restriction of movement on the eye itself and how it affects the eye excluding the movement.

Based on the context provided, here are the signs and symptoms of Brown's tendon sheath syndrome:

1. Limited ability to look upward and inward: The typical sign of Brown syndrome is a limited ability to look upward and inward with the affected eye(s).
2. Vertical diplopia: Double vision when looking up or down.
3. Poor binocular vision/stereopsis: Difficulty seeing in 3D or judging distances.
4. Orbital pain and tenderness: Pain or discomfort in the orbit (eye socket) area.
5. Pain with eye movement: Pain or discomfort when moving the affected eye(s).
6. Abnormal head position: The head may be tilted or turned to compensate for the limited eye movement.
7. Clicking sound: A clicking or snapping sound may be heard when moving the affected eye(s).
8. Eye turn: The affected eye may turn outward or inward, away from its normal position.
9. Strabismus: Eyes not lined up (in alignment) with each other.
10. Ptosis: Droopy eyelid.

Please note that these symptoms can vary in severity and may be temporary or permanent, depending on the underlying cause of Brown's tendon sheath syndrome.

Brown's tendon sheath syndrome, also known as Brown syndrome, can be diagnosed through several diagnostic tests.

• Forced Duction Testing: This test is very useful in the diagnosis of Brown syndrome and will demonstrate restriction to passive elevation in adduction, accentuated by forced duction testing [4]. It involves gently moving the eye in different directions while the patient is under anesthesia or sedation.
• Imaging Tests: Imaging tests such as MRI (Magnetic Resonance Imaging) of the orbit can help give more information about the superior oblique muscle tendon and may be used to diagnose acquired Brown syndrome, especially if associated with pain, discomfort, signs of inflammation, or an atypical presentation [7].
• Eye Exam: A thorough eye exam is also part of the diagnostic process for Brown's tendon sheath syndrome. This includes a detailed examination of the eyes' movements and alignment.
• CT (Computed Tomography) Scan: CT scans have been used to diagnose Brown syndrome, particularly in assessing the thickening of the reflected tendon [9].
• Prism Cover Test: The prism cover test is another diagnostic tool that can be used to detect Brown's tendon sheath syndrome.

It's worth noting that diagnosis begins with a health history and physical exam, including a thorough eye exam. Young children may not be able to follow the directions of a normal eye exam [5].

Brown's tendon sheath syndrome, also known as superior oblique tendon sheath syndrome, can be treated with various medications to alleviate symptoms and reduce inflammation.

Corticosteroids: Corticosteroids are often used to treat Brown's tendon sheath syndrome caused by inflammation. These medications work by reducing swelling and inflammation in the affected area. According to search results [5], corticosteroids may be effective in treating this condition, especially when used in conjunction with other treatments.

Nonsteroidal anti-inflammatory medicine (NSAIDs): NSAIDs, such as ibuprofen, can also be used to treat Brown's tendon sheath syndrome caused by inflammation. These medications work by reducing pain and inflammation in the affected area. Search results [7] and [9] suggest that NSAIDs may be effective in treating this condition.

Steroid injections: In some cases, steroid injections may be necessary to reduce inflammation and alleviate symptoms. According to search results [8], steroid injections can be used to treat Brown's tendon sheath syndrome caused by inflammation.

It is essential to note that the treatment of Brown's tendon sheath syndrome depends on its cause and severity. A healthcare professional should be consulted for proper diagnosis and treatment.

References: [5] - Most cases resolve with anti-inflammatory therapy; however, local injections may be needed in refractory cases.[4] [7] - Brown syndrome caused by inflammation may be treated with corticosteroids. Or it may be treated with nonsteroidal anti-inflammatory medicine, such as ibuprofen. [8] - In cases of Brown syndrome caused by inflammation, possible treatments may include steroid injections, steroids by mouth and other medications that suppress the ... [9] - Brown syndrome caused by inflammation may be treated with corticosteroids. Or it may be treated with nonsteroidal anti-inflammatory medicine, such as ibuprofen.

Brown's tendon sheath syndrome, also known as Brown syndrome, has several differential diagnoses that need to be considered for accurate diagnosis and treatment.

Conditions to Rule Out:

• Inferior oblique muscle palsy [3]
• Superior oblique over-action [3]

These conditions can present with similar symptoms to Brown's tendon sheath syndrome, such as restricted eye movement. However, they have distinct underlying causes and require different management approaches.

Other Conditions to Consider:

• Congenital and acquired causes of superior oblique tendon sheath dysfunction [4]
• Inflammation of the area where the superior oblique attaches to the eye socket, from adult and juvenile rheumatoid arthritis, systemic lupus erythematosus, and other conditions [8]

These conditions can also present with symptoms similar to Brown's tendon sheath syndrome, such as restricted eye movement. A thorough medical history and physical examination are essential to rule out these conditions.

Key Diagnostic Features:

• Restricted passive and active elevation of the eye in adduction [4], [5]
• Congenital and acquired causes of superior oblique tendon sheath dysfunction [4]

These features are critical for diagnosing Brown's tendon sheath syndrome. A detailed history and physical examination, including specific eye movement tests, can help confirm the diagnosis.

References:

[3] Differentiation from Inferior Oblique muscle palsy and Superior Oblique over-action is essential for accurate diagnosis. [4] Congenital and acquired causes of superior oblique tendon sheath dysfunction are key diagnostic features. [5] Restricted passive and active elevation of the eye in adduction is a hallmark symptom of Brown's tendon sheath syndrome. [8] Inflammation of the area where the superior oblique attaches to the eye socket can mimic symptoms of Brown's tendon sheath syndrome.