The superior oblique muscle is innervated by cranial nerve IV and the lateral rectus muscle by cranial nerve VI. Br J Ophthalmol. Bethesda, MD 20894, Web Policies American Academy of Ophthalmology. The pathophysiology is varied, with no clear consensus. Phillips PH, Hunter DG. Following ocular surgery (Ex. The diagnosis of Brown Syndrome is based on the clinical findings and history. Urrets-Zavalia A. Abduction en la elevacion. : Thyroid ophthalmopathy; secondary to superior oblique overaction). Restriction of elevation in abduction after inferior oblique anteriorization. Subjects: We studied 33 eyes with oblique dysfunction (9 with presumed congenital superior oblique palsy [SOP], 13 with acquired SOP, 7 with Brown syndrome, and 4 with inverted Brown . A and V patterns seen in exodeviation and esodeviation. Vertical misalignments of the eyes typically results from dysfunction of the vertical recti muscles (inferior and superior rectus) or of the oblique muscles (the inferior oblique and superior oblique). Kushner BJ. -, Coats DK, Paysse EA, Orenga-Nania S. Acquired Pseudo-Brown's syndrome immediately following Ahmed valve glaucoma implant. The incidence of Brown's Syndrome was unrelated to tuck size. Brown's Syndrome in the absence of an intact superior oblique muscle. Superior Oblique Muscle Involvement in Thyroid Ophthalmopathy. Smith TJ Thyroid-associated Ophthalmopathy: Emergence of Teprotumumab as a Promising Medical Therapy. : A left superior oblique overaction causes a right hypertropia on right gaze. This page has been accessed 163,866 times. If horizontal recti are displaced superior- or inferiorly, they act as additional elevators or depressors. Apart from the basic strabismus work-up, the additional assessment needed in the presence of patterns is to look for: The management of pattern strabismus can be difficult. Brown A longitudinal long-term study of spontaneous course. However, a characteristic V-pattern (divergence on upgaze) will be noted in Brown syndrome, in contrast to the A-pattern (divergence on down-gaze) seen in superior oblique over-action with or without associated IO plasy. [4] Sometimes bilateral involvement can be masked due to an asymmetrical involvement. It may be addressed surgically with a Y-splitting procedure of the ipsilateral lateral rectus muscle. Furthermore, careful history including associated symptoms and other past medical history can help distinguish a CN 4 palsy from other items on the differential.
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