Monocular partial/sector occlusion therapy: a procedure to inhibit diplopia in Brown syndrome

Brown syndrome is recognized clinically as an absence or restriction of elevation in adduction. It often causes intermittent diplopia.

This article includes discussion of a child, age 3 years, 11 months, who underwent surgery of the right eye for a left hypertropia. By age 5 years, he complained to his mother of daily, intermittent diplopia, eye pain in both eyes (OU), and frontal headaches. Additional strabismus surgeries OU were done at ages 6¾ years and 8¼ years. At age 10½ years, the ophthalmologist first noted suspicion of acquired right Brown syndrome, which was definitively diagnosed at age 14. At that time, the original complaints remained unresolved, and his mother was hesitant to allow a fourth surgery. Thus, a procedure was devised to partially occlude a precise sector of the spectacle lens for the noninvolved eye in Brown syndrome. This successfully inhibited the daily, intermittent diplopia while allowing fusion and normal stereopsis in primary and down gaze. Also, it resolved the associated eye pain OU and headaches.

Monocular partial/sector occlusion therapy to inhibit intermittent diplopia in Brown syndrome offers a sensible alternative to surgery for those with normal or near-normal alignment, fusion, and stereopsis in primary and down gaze. For those who contemplate surgery, had failed surgery, or require treatment of underlying disease, monocular partial/sector occlusion therapy can serve as an excellent adjunct. Also, it may be attempted in other incomitant strabismic deviations with bothersome diplopia limited to specific positions of gaze.