Post-traumatic superior oblique tendon nodule associated with acquired Brown syndrome

A 67-year-old woman presented with a left hypotropia and eye pain after a traumatic fall. She had multiple left orbital wall fractures and an acquired limitation to elevation in all gazes, worse in adduction, suggestive of Brown syndrome. During strabismus surgery, a white nodule on the superior oblique tendon was identified and excised. Histopathology of the nodule revealed densely aggregated inflamed fibrovascular and fibrocollagenous scar tissue. Superior oblique rupture with spontaneous reparative reapproximation resulting in nodular formation is uncommon. We speculate that resulting tendon shortening may have contributed to the apparent Brown syndrome in this patient.