Related Experiment Video
Updated: Nov 8, 2025
Author Spotlight: Ex Vivo OCT-Based Multimodal Imaging of Human Donor Eyes for Research into Age-Related Macular Degeneration
Published on: May 26, 2023
The "Eyelet Sign" as an MRI Clue for Inflammatory Brown Syndrome
Fabienne C Fierz1, Klara Landau, Raimund Kottke
1Department of Ophthalmology (FCF, KL, KPW, CG-K), University Hospital Zurich and University of Zurich, Zurich, Switzerland ; Department of Diagnostic Radiology (RK), University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland ; Institute of Neuroradiology (WW), University Hospital Zurich and University of Zurich, Zurich, Switzerland ; Department of Ophthalmology (VS), Cantonal Hospital St. Gallen, St. Gallen, Switzerland ; and Department of Neurology (KPW), University Hospital Zurich and University of Zurich, Zurich, Switzerland .
Inflammatory acquired Brown syndrome shows specific MRI findings at the superior oblique tendon-trochlea complex. This "eyelet sign" aids diagnosis and treatment guidance in children and adults.
Area of Science:
- Ophthalmology
- Radiology
- Pediatric Ophthalmology
Background:
- Brown syndrome involves restricted eye elevation in adduction.
- Acquired forms stem from inflammation, trauma, or surgery affecting the superior oblique (SO) tendon's movement.
- This study focuses on MRI findings in acquired inflammatory Brown syndrome.
Purpose of the Study:
- To present MRI findings in pediatric and adult patients with inflammatory acquired Brown syndrome.
- To identify characteristic imaging features of this condition.
- To correlate MRI findings with clinical diagnosis and treatment.
Main Methods:
- Retrospective review of clinical and MRI data from 6 patients (4 children, 2 adults).
- Analysis of orbital MRI scans focusing on the SO tendon-trochlea complex.
- Median follow-up of 23 months.
Main Results:
- Orbital MRI revealed inflammatory changes in the SO tendon-trochlea complex in all patients.
- A distinctive "eyelet sign" was observed: circumferential trochlear enhancement with central sparing.
- Motility restriction improved with spontaneous resolution or anti-inflammatory treatment.
Conclusions:
- MRI can detect inflammatory changes in the trochlea-tendon complex in acquired Brown syndrome.
- The "eyelet sign" on MRI is a key finding for confirming the diagnosis.
- MRI findings can guide appropriate treatment strategies for acquired Brown syndrome.
