Clinical progression of untreated bilateral Brown syndrome

Abstract

Purpose: To present the natural history of bilateral Brown syndrome in patients without surgical intervention.

Methods: The medical records of cases of bilateral Brown syndrome not treated surgically with long-term follow-up from 1987 to 2012 were retrospectively reviewed.

Results: A total of 9 cases were included. The majority of patients in this series had idiopathic Brown syndrome, were diagnosed in early childhood, and had minimal ophthalmic sequelae. Of the 9 patients, 8 were diagnosed with bilateral Brown syndrome at their first ophthalmologic assessment. The age range at first diagnosis was 3-6 years of age. The mean follow-up period was 7.9 years; the median, 5 years (range, 1-20 years). At the most recent follow-up visit, 6 patients remained orthophoric in primary position; 1 patient had a micro-esotropia; 1 had developed an exotropia of 30 D; and 1 had developed a right hyperphoria. All patients without concurrent horizontal strabismus developed normal stereopsis and visual acuity, with minimal or no compensatory head position or downshoot in adduction.

Conclusions: Patients in this case series show minimal, if any, long-term visual impairment.