Korean J Ophthalmol.  2010 Feb;24(1):53-56. 10.3341/kjo.2010.24.1.53.

A Case of Acquired Brown Syndrome after Surgical Repair of a Medial Orbital Wall Fracture

• Seo IH
• Rhim JW
• Suh YW
• Cho YA

• KMID: 1098795
• DOI: http://doi.org/10.3341/kjo.2010.24.1.53

Abstract

A case of acquired Brown syndrome caused by surgical repair of medial orbital wall fracture is reported in the present paper. A 23-year-old man presented at the hospital with right periorbital trauma. Although the patient did not complain of any diplopia, the imaging study revealed a blow-out fracture of the medial orbital wall. Surgical repair with a calvarial bone autograft was performed at the department of plastic surgery. The patient was referred to the ophthalmologic department due to diplopia that newly developed after surgery. The prism cover test at distant fixation showed hypotropia of the right eye, which was 4 prism diopters (PD) in primary gaze, 20 PD in left gaze, while orthophoric in right gaze. Eye movement of the right eye was markedly limited on elevation in adduction with normal elevation in abduction with intorsion in the right eye present. Forced duction test of the right eye showed restricted elevation in adduction. Computerized tomography scan of the orbits showed the right superior oblique muscle was entrapped between the autografted bone fragment and posterior margin of the fracture. When repairing medial orbital wall fracture that causes Brown syndrome, surgeons should always be careful of entrapment of the superior oblique muscle if the implant is inserted without identifying the superior and posterior margin of the orbital fracture site.

Keyword

Acquired Brown syndrome; Blow-out fracture; Superior oblique muscle entrapment; Ocular motility disorders; Orbital fractures

MeSH Terms

Bone Transplantation/*adverse effects
Diplopia/etiology
Humans
Male
Ocular Motility Disorders/*etiology/radiography
Ophthalmologic Surgical Procedures/*adverse effects
Orbital Fractures/*surgery
Tomography, X-Ray Computed
Transplantation, Autologous
Young Adult

Figure

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  Fig. 1 A computerized tomography scan was performed before surgery and showed a medial orbital wall fracture (arrow).

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  Fig. 2 Postoperative computerized tomography scan of the orbits showed the right superior oblique muscle was entrapped between the autografted bone fragment and posterior margin of the fracture (arrow).

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  Fig. 3 After repair of the blow-out fracture, limitation of elevation in adduction of the right eye developed (arrow) while elevation in abduction was normal.

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  Fig. 4 Fundus examination showed intorsion of the right eye.

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