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Brown Syndrome Medication

  • Author: Kenneth W Wright, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Aug 26, 2014

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.


Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Motrin, Ibuprin, Advil)


Inhibits inflammatory reaction and pain by decreasing the activity of the enzyme cyclooxygenase, which results in prostaglandin synthesis.

Contributor Information and Disclosures

Kenneth W Wright, MD Director, Wright Foundation for Pediatric Ophthalmology and Strabismus Ophthalmology, Cedars-Sinai Medical Center; Clinical Professor of Ophthalmology, Keck School of Medicine of the University of Southern California

Kenneth W Wright, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Ophthalmological Society

Disclosure: Received royalty from Titan Surgical for inventor; Received royalty from Oxford University Press for author; Received royalty from Springer for author.


Maria Gabriela Salvador, MD, MD 

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.


Anastasios J Kanellopoulos, MD Assistant Program Director, Clinical Associate Professor, Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York University

Anastasios J Kanellopoulos, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Eye Bank Association of America, and International Society of Refractive Surgery

Disclosure: Nothing to disclose.

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A 3-year-old patient with acquired right Brown syndrome. Marked limitation of elevation in adduction is present in the right eye. Pseudo-overaction of the left inferior oblique is present. Courtesy of Kenneth Wright, MD.
The same patient as in the image above, 6 years later. The patient shows normal eye movements, and no signs of Brown syndrome. A spontaneous resolution occurred over a 2-year period. Courtesy of Kenneth Wright, MD.
This patient has the longest follow-up in the silicone tendon expander group at 11 years. A. Preoperative composite photograph of eye movements, showing right Brown syndrome. The patient underwent silicone tendon expander, 6 mm right eye. B. Postoperative photograph 3 years after surgery, showing full ocular motility. C. Postoperative photograph 11 years after surgery, showing continued normal ocular motility. Courtesy of Kenneth Wright, MD.
Composite photographs, showing left Brown syndrome with marked limitation of elevation in adduction. Courtesy of Kenneth Wright, MD.
Fundus torsion (direct view). The bottom set of fundus photographs represents downgaze; the center photographs, primary position; and the top photographs, upgaze. Note that in the top set of photographs, the left fundus is intorted as the foveal fixation is slightly above the top of the optic disc. Courtesy of Kenneth Wright, MD.
Table. Differential Diagnoses: Clinical Features of Brown Syndrome, Inferior Oblique Paresis, and Superior Oblique Overaction
 Brown syndrome (inelastic superior oblique muscle-tendon complex) Primary superior oblique overaction Inferior oblique paresis
Limitation of elevation in adductionUsually severe (-3 to -4)Usually mildUsually severe (-3 to -4)
Limitation of elevation in adductionCommon (mild to moderate)NoNo
Bilateral involvementRare (5-10%)CommonUnusual
Vertical deviationNone or small (< 10 PD)Bilateral small (< 10 PD)Unilateral large (>10 PD)
Superior oblique overactionNone or minimalYes, markedYes, marked
PatternNone or V-pattern Y-subtype with divergence in upgazeA-pattern Lambda-subtype with divergence in downward gazeA-pattern, often convergence in upgaze
Fundus torsionNone in primary or downgaze, intorsion in upgazeIntorsion in primary, increasing in downgazeIntorsion in primary, increasing in upgaze
Head title testNegativeNegativePositive
Forced ductionsPositiveNegativeNegative
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