Management of superior oblique palsy after surgery for true Brown's syndrome

Thirty patients requiring surgery for true Brown's syndrome were examined postoperatively. Follow-up ranged from three months to 20 years. Eight-five percent of patients demonstrated some degree of superior oblique palsy, with 54% having a decompensated condition and 30% requiring a second surgical procedure. Patients with marked preoperative restriction appear to be at increased risk for developing a decompensated superior oblique palsy postoperatively. Solutions to this problem are suggested: 1) perform tenotomy at insertion and preserve the adjacent intermuscular septum so a less crippling effect is seen; 2) combine tenotomy with inferior oblique weakening initially in those patients with marked preoperative restriction.