Late recurrence of idiopathic Brown’s syndrome successfully treated with oral corticosteroids

Author:

Lo Cody1,Micieli Jonathan A234ORCID

Affiliation:

1. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

2. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada

3. Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

4. Kensington Vision and Research Centre, Toronto, Ontario, Canada

Abstract

Introduction: Idiopathic Brown’s syndrome is a restrictive strabismus of the superior oblique tendon that often presents in pediatric populations and rarely occurs in adults. Case description: We present here a case of a 41-year-old man with an idiopathic left Brown’s syndrome that recurred after presenting with similar symptoms 14 years prior that was originally treated with oral corticosteroids. This patient had a negative work up for connective tissue disease and only exhibited subtle left trochlear thickening on orbital MRI with contrast. Since he had a good response to oral corticosteroids in the past, this repeat occurrence was treated with oral Prednisone and he promptly responded. His double vision resolved within 2 weeks and he continued to have a normal examination 6 months after presentation. Conclusion: We suspect this case was related to a subclinical inflammatory process resulting in the MRI findings and response to steroids. This case demonstrates that idiopathic Brown’s syndrome can recur more than a decade later in adults and oral corticosteroids are an effective treatment option even in the absence of an underlying rheumatological condition.

Publisher

SAGE Publications

Subject

Ophthalmology,General Medicine

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