Wang Yao, McCulley Timothy J, Doyle Jefferson J, Chang Jessica, Lee Michael S, McClelland Collin M
Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.
Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA.
Neuroophthalmology. 2017 Jun 12;42(1):49-51. doi: 10.1080/01658107.2017.1329321. eCollection 2018 Feb.
Brown syndrome is characterised by impaired supraduction worse in adduction due to a restricted superior oblique tendon passing through the trochlea. A few reports have previously described Brown syndrome after upper eyelid surgery, including blepharoplasty and ptosis repair. The authors describe two additional cases of Brown syndrome following ptosis repair. The first case is a 65-year-old woman with new-onset vertical binocular diplopia following bilateral levator advancement surgery. Ocular motility examination demonstrated moderate impairment of elevation in adduction. The second case is a 35-year-old woman who presented with new-onset intermittent binocular diplopia following right upper lid ptosis repair. Examination revealed large vertical fusional amplitudes and a large left intermittent hyperphoria in an alignment pattern consistent with Brown syndrome. Despite presenting after surgery, these cases differ in mechanism. The first case likely occurred due to intraoperative impairment of the superior oblique tendon sheath or trochlea, whereas the second case represented an unmasking of a long-standing, previous vertical strabismus that was consistent with a Brown syndrome pattern.
布朗综合征的特征是由于上斜肌腱穿过滑车受限，导致内收时上转功能受损，在内收位时更明显。此前已有一些报告描述了上睑手术后出现的布朗综合征，包括眼睑成形术和上睑下垂修复术。作者描述了另外两例上睑下垂修复术后发生布朗综合征的病例。第一例是一名65岁女性，在双侧提上睑肌缩短术后出现新发垂直性双眼复视。眼肌运动检查显示内收时上转功能中度受损。第二例是一名35岁女性，在右上睑上睑下垂修复术后出现新发间歇性双眼复视。检查发现有较大的垂直融合幅度，以及与布朗综合征一致的眼位异常模式，表现为左眼间歇性上斜视。尽管这些病例是在手术后出现的，但机制有所不同。第一例可能是由于手术中对上斜肌腱鞘或滑车的损伤所致，而第二例则是长期存在的、先前的垂直斜视（与布朗综合征模式一致）被暴露出来。
