What Is Superior Oblique Tendon Sheath Syndrome?
Superior Oblique Tendon Sheath Syndrome which is also known by the name of Brown Syndrome is an extremely rare ophthalmologic disorder in which there are significant defects in the movements of the eye. This condition can be both inherited as well as acquired.
The movement of the eyes are controlled by muscles which allow the eyeball to move up or down or sideways. The eyeball is surrounded by the Superior Oblique Tendon Sheath. Superior Oblique Tendon Sheath Syndrome is caused by abnormalities of this tendon sheath limiting the motion of the eyes.
The abnormalities of the tendon sheath may be thickening of the sheath, shortening, or inflammation of the tendon sheath which tends to restrict movement of the eyeballs with the individual not being able to move the eye as a result of Superior Oblique Tendon Sheath Syndrome.
What Are The Causes Of Superior Oblique Tendon Sheath Syndrome?
The root cause of the congenital form of Superior Oblique Tendon Sheath Syndrome is unclear The exact cause of most cases of Congenital Brown Syndrome is not known but the symptoms tend to occur due to shortening of tendon sheath of the superior oblique muscle or thickening of the sheath which then restricts the movement of the eyeballs.
The acquired form of Superior Oblique Tendon Sheath Syndrome may occur as a result of a trauma to the eyeball or the adjoining tendon sheath, a result of an injury to that portion of the eye during a surgical procedure, or as a result of inflammation due to conditions like rheumatoid arthritis or SLE.
Some cases of congenital Superior Oblique Tendon Sheath Syndrome have been reported to be autosomal dominant in pattern meaning that a single copy of the defective gene from any parent is good enough for the baby to have this Superior Oblique Tendon Sheath Syndrome.
What Are The Symptoms Of Superior Oblique Tendon Sheath Syndrome?
The main symptom of Superior Oblique Tendon Sheath Syndrome is limited movement of the affected eye. An individual with Superior Oblique Tendon Sheath Syndrome will have difficulty or in some cases complete inability to move the eye sideways or up and down.
The affected eye may not look in alignment with the unaffected eye when trying to look upwards with the affected eyeball remaining static. Ptosis is also a symptom of Superior Oblique Tendon Sheath Syndrome along with palpebral fissures and strabismus.
When the individual with Superior Oblique Tendon Sheath Syndrome is looking straight ahead there may be hypotropia noted in the affected eye. Usually only one eye is affected by this condition but in some cases both eyes have been reported to be affected by Superior Oblique Tendon Sheath Syndrome.
How Is Superior Oblique Tendon Sheath Syndrome Treated?
Mild cases of Superior Oblique Tendon Sheath Syndrome do not require any treatment, especially when it is the congenital form of this disorder. The alignment of the eye tends to improve with time and as the child grows.
In cases of acquired form of Superior Oblique Tendon Sheath Syndrome, surgery may be required to correct the deformity and realign the eyes. During the surgical procedure some segment of the tendon sheath which connects to the superior oblique muscle may be removed to restore normal motion of the eyeball.
In majority of the cases, normal eye function is restored and the patient is cured but there is always a tendency for a recurrence in cases of Superior Oblique Tendon Sheath Syndrome.
If the condition is caused due to rheumatoid arthritis or lupus then treatment of that condition usually is enough to treat the symptoms of Superior Oblique Tendon Sheath Syndrome.
- American Association for Pediatric Ophthalmology and Strabismus. (n.d.). Brown Syndrome. https://aapos.org/glossary/brown-syndrome
- National Organization for Rare Disorders (NORD). (2017). Brown Syndrome. https://rarediseases.org/rare-diseases/brown-syndrome/
- American Academy of Ophthalmology. (2021). Brown Syndrome. https://www.aao.org/disease-review/brown-syndrome-2
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