Clinical Profile and Surgical Outcomes in Brown Syndrome – A Retrospective Case Series

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Authors: Anupam Singh ¹; Nandu Prakash ¹; Pankti Buch ¹; Anue Choudhary ¹; Barun Kumar ²
Authors‘ workplace: Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, India ¹; Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India ²
Published in: Čes. a slov. Oftal., 82, 2026, No. Ahead of Print, p. 1-8
Category: Original Article
doi: https://doi.org/10.31348/2026/20

Overview

Aim: To evaluate the clinical, sensory, and motor characteristics of patients with Brown syndrome treated at a tertiary health care center, with a focus on the long-term outcomes of conservative and surgical interventions.

Material and Methods: This retrospective case series evaluated 14 patients diagnosed with Brown syndrome. A comprehensive clinical assessment included a detailed history, best-corrected visual acuity, a prism cover test for primary position deviation, nine-gaze motility with quantitative elevation-in-adduction, fundus torsion, and sensory status. Of 14 patients, 11 had congenital Brown syndrome and 3 had acquired forms. Congenital cases were stratified by severity using standard criteria: mild (isolated elevation deficit in adduction with orthophoria; n = 4), moderate (downshoot in adduction with minimal/no primary deviation; n = 2), and severe (significant primary vertical deviation ± abnormal head posture; n = 5). Mild to moderate cases underwent observation with appropriate refractive correction, and acquired cases underwent etiology-specific management, which also included observation for the restrictive strabismus. Severe congenital cases (n = 5) underwent superior oblique chicken suture lengthening.

Results: Following a one-year follow-up, mild (n = 4) and moderate (n = 2) congenital cases remained stable without progression under conservative management, whereas acquired etiologies (n = 3) showed resolution after etiology-targeted management. Five patients with the congenital severe form achieved successful primary position alignment after superior oblique chicken suture lengthening, with improvements in objective torsion, abnormal head posture, and stereoacuity, without any adverse outcomes.

Conclusion: Most cases of Brown syndrome (64%) can be managed by adopting a conservative approach, depending on the etiology and severity. Only severe forms with significant primary position deviation require surgical intervention. Superior oblique chicken suture lengthening is a safe procedure that yields favorable long-term outcomes with minimal complications.