Spontaneous resolution in patients with congenital Brown syndrome

Brown syndrome is characterized by a restriction of active and passive elevation in adduction. It can be congenital, acquired, intermittent, or constant. Spontaneous improvement has been reported in all types but is less common in congenital and constant cases.

A retrospective review of patients seen between 1992 and 2002 was conducted at our tertiary referral center of all new referrals with a diagnosis of constant congenital Brown syndrome that was previously untreated.

Thirty-two patients were identified (22 female and 10 male patients), with an age range at referral of between 1 and 14 years. The right eye was affected in 14 patients, and 3 patients had bilateral Brown syndrome. Twenty-nine (91%) demonstrated binocular vision. Nineteen patients had an abnormal head posture. Twenty-four (75%) patients had some improvement in their ocular movements without any intervention. The best improvement was from a -3 limitation to full movement. Of 6 patients with a "click," 5 improved. Pain was a problem in 10 patients, 8 of whom improved. Diplopia was a symptom in 13 patients, of whom 11 improved. The final review ranged from 6 months to 9.5 years after the first visit. Five patients who had no spontaneous improvement underwent surgery and obtained improvement.

Spontaneous improvement occurred in 75% of patients. Our management is to be cautious with treatment and adopt an observational approach with these patients.