Pseudo-Brown's Syndrome With Superior Rectus Muscle Recession: A New Complication of Vertical Muscle Surgery

Abstract

Purpose: : Superior rectus surgery may cause unique complications including ptosis and eyelid retraction. We describe a new strabismus complication causing a profound limitation of elevation in adduction, simulating a Brown’s syndrome. We present a small series of patients with an unusual complication of superior rectus muscle insertion into the superior oblique tendon after recession.

Methods: : Retrospective chart review.

Results: : Three patients with the operative finding of superior rectus muscle insertion into the anterior border of the superior oblique muscle--without direct attachment to the sclera--after previous superior rectus muscle recession were identified. Findings included a large hypotropia of the affected eye with duction and version findings suggesting Brown’s syndrome. Exploration, separation from the superior oblique tendon and advancement of the superior rectus muscle with direct scleral attachment was corrective in two cases. The third case required further resection of the superior rectus muscle and superior oblique tenotomy.

Conclusions: : Identification of the etiology of a vertical deviation resembling a Brown’s syndrome following superior rectus recession surgery is important. Non-scleral insertion of the superior rectus muscle into the superior oblique tendon should be suspected when an unexpected large hypotropia occurs after superior rectus muscle recession.

Keywords: strabismus: diagnosis and detection • strabismus: etiology • strabismus