Superior oblique tendon sheath syndrome of Brown

Twenty-four patients with true superior oblique tendon sheath syndrome (Brown's syndrome) were extensively examined surgically. Since a tight or short anterior sheath of the superior oblique tendon was not present in any of our cases, we are not able to support the theory that this form of the syndrome is due to a congenital anomaly of the anterior sheath. The superior oblique tendon was taut and shortened in only two cases; in all the others it was limp, even in attempts to elevate the eye passively in adduction. Thus the majority of cases of constant congenital Brown's syndrome remain unexplained with no obvious abnormality found at surgery in any of the six extraocular muscles. However, our surgical findings did suggest that a restrictive band posterior and inferior to the globe was responsible for the limited elevation in adduction.