伯朗咖啡–Brown syndrome

Etiology and pathogenesis of Brown syndrome:

Inflammation or thickening of SO tendon sheath,

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* 表現：
=> downshoot on adduction

★ 原因：眼球在內展時，SO的垂直作用最大，因SO tendon被限制住，故表現出SOOA的作用，眼球於是downshoot。

* 如何與monocular elevation deficiency分別？
=> exotropia in upgaze in Brown syndrome
★ 原因：眼球在外展時，SO的垂直作用最小，故可避開SO tendon的restrictive limitation

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Grading:

Severe: primary gaze hypotropia and down-shoot in adduction
Moderate: down shoot in adduction
Mild: neither

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Causes:

* Idiopathic
* Congenital
* Trauma
* Marfan’s syndrome/acromegaly
* Rheumatoid arthritis
* Dental extraction/sinus surgery
* RD /glaucoma explanted surgery

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Treatment of underlying inflammation
=> Oral or local steroid injection

Surgery indicated in severe cases
* SO tenotomy / tenectomy, with or without IO weakening
* Aware of post-operative SO palsy

* Harada-Ito surgery會使Brown syndrome更糟。