Team Altman: Brown's Syndrome

Joshua had an appointment with the eye doctor today. Myself and his pediatrician had noticed his right eye does not look up quite right, so we decided to get it checked out and see if it was anything. It turns out there is a name for this...Brown's Syndrome. About 1 in every 450 children are born with this and its description is pretty simple. The syndrome was named in 1950 after Harold W. Brown published his findings about an unusual motility disorder of the eye characterized by the following:

"limited elevation in adduction; divergence in straight upgaze (V-pattern);and compensatory chin elevation for binocular fusion."

Ok so here is a quick review from the Biology major...sorry I cant help it =) Throughout our body we have LOTS of tendons and ligaments. Remember ligaments connect bone to bone, and tendons connect muscle to bone. Tendons work together with muscles and Brown syndrome is caused by a malfunction of the superior oblique tendon which is right behind the eye, causing the eye to have difficulty moving upward, particularly during adduction (when eye turns towards the nose). Basically the tendon is too tight/short so it doesn't allow the eye to move freely up all the way, which is what we see in Joshua's right eye.

Now to the untrained eye you probably would never see the difference, but to the doctor and mommy it is obvious. While it most likely is not causing discomfort or pain, it can cause problems in dexterity and double vision. Think about a lot of common things that require your eyes to look up....

1. playing most sports....dribbling basket ball and shooting
2. sitting in a desk at school and copying down something from the white board
3. driving and looking in your rear view mirror

The good news about this syndrome is it does not get progressively worse, but the bad news is it wont disappear on its own. The only way to fix this is through surgery. I am told by the doctor it is a quick 30 minute outpatient procedure in which they loosen the tendon by inserting a silicone band in the middle to make it longer. They use dissolving stitches and Joshua is back to 100% after about 4 days. This procedure is the most common and is very effective when performed accurately. As with any surgery there are chances for error, but Dr. Packwood performs about 3 of these every week, so he has lots of experience.

For now, here are some pictures of this happy boy at the park the other day. This is a daily routine, Joshua will now go to the door around 8:30am every morning and know its time to go to the park. But the part where he screams when we leave to walk home....that is another story!