A 3-year-old boy is brought with a squint. His visual acuity is 6/60 in the right eye and 6/6 in the left. The right eye shows constant left hypertropia with no movement of the left eye when covered (no re-fixation). The pattern of movements is: elevation restricted in adduction and depression restricted in abduction of the right eye. The diagnosis is:
- A Right inferior oblique palsy
- B Right Brown's syndrome ✓
- C Right superior oblique palsy
- D Duane's retraction syndrome type II
Correct answer: B. Right Brown's syndrome
Explanation
Brown's syndrome (superior oblique tendon sheath syndrome) is caused by a tight or inelastic superior oblique tendon/sheath preventing the inferior oblique from lifting the adducted eye. The hallmark is restriction of elevation in adduction (cannot look 'up and in'). The right eye shows limited elevation in adduction, and the pattern of restriction in adduction with depression in abduction (the V-pattern upshoot) differentiates it from IO palsy (which has overaction in adduction) and SO palsy (which has limited depression in adduction).
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.