Surgical Treatment of Congenital Brown Syndrome, A Review

Background and Purpose: Brown syndrome is an ocular motility disorder that was first described by Harold Brown in 1950. The pathology is attributed to the superior oblique tendon and sheath. It creates a vertical deviation with limitation of elevation of the affected eye in adduction. There is no standard management strategy. The purpose of this paper is to summarize the methods introduced so far, along with their advantages and disadvantages.Patients and Method: Related articles from 1950 to 2022 were searched in Google Scholar, PubMed, and Scopus based on the keywords of this article.Results: Management of Brown syndrome includes observation and, in some cases, surgical intervention. Until now, several surgical approaches have been reported, including nongraded procedures (superior oblique nasal tenotomy or tenectomy) and graded procedures (superior oblique tendon lengthening, split-tendon lengthening, and superior oblique tendon thinning).Conclusion: Since surgical results are unpredictable and spontaneous recovery has been reported in 75% of patients, care must be taken in selecting patients for surgery. It seems that graded and reversible procedures appear to have advantages over other methods.