Brown syndrome is a rare form of disease and the person who is affected faces problems in elevation of eye. This problem is caused due to defects in superior oblique tendon and people face problems particularly when their eye moves towards the nose. There are two types of care possible for this problem, they are as follows:
It is very difficult to get spontaneous resolution in cases of Brown syndrome. Only in some of the non-traumatic cases the fast resolution is possible. Since there is slow progress in the resolution process it is good to try out the conservative approach. Patients who suffer from acquired Brown syndrome can be evaluated for any coexisting disease. If there is some other systemic disease like sinusitis or rheumatoid then the disorder must be treated accordingly.
It is important to avoid all the systemic disease and then start the treatment of Brown syndrome. The main reason behind this is that the medicines used in treating this disease are anti-inflammatory. One of the best choices for this disease is Oral ibuprofen. Sometimes people use injections containing local steroids of trochlea. If the inflammatory process is controlled then the inflammatory Brown syndrome can show spontaneous resolution.
Surgery is done in severe cases like problems in chin elevation and limitation in elevation in the adduction. Surgery is mainly done in cases that last for too long and don’t show much improvement. The main process involved in the treatment of the superior Brown syndrome involves improvement in the length of tendon. One should release any kind of restriction and also try to avoid oblique palsy.
To go through the process properly the first thing that needs to be done is to identify the cause of the restriction. One of the most preferred methods is Wright silicone tendon expander. In this technique superior oblique tendon is elongated with the Tenotomy procedure. A segment of medical grade silicone is inserted that has 240 retinal bands and is kept between the ends of tendon. It is important to place silicone inside the tendon capsule without damaging the floor of tendon capsule. This has been the most effective technique but it is difficult to perform and requires precision.
There is another technique of superior oblique split tendon lengthening. In this technique the nasal side tendon that is present on the superior rectus muscle is split. Tendon halves are removed and their length is increased and the tendon is again joined.
In a technique known as Suture Bridge the doctors place a non-absorbable suture to connect the ends of superior oblique tendon. This is very effective in preventing oblique palsy and has proved to be good in correction of the Brown syndrome.