Brown's syndrome is best described by which statement?

• A. It is primarily an inferior oblique issue
• B. It is always congenital
• C. It features elevation deficits with adduction
• D. It typically presents with a large hypotropia in primary gaze

Answer: (C)

Brown’s syndrome is a mechanical restriction of the superior oblique tendon as it passes through the trochlea, leading to an inability to elevate the eye when it is in adduction. This pattern means elevation is preserved when the eye is abducted, but is limited when the eye moves toward the nose. Clinically, you often see a small or normal primary gaze and normal abduction, with a pronounced deficit during adduction. The condition can be congenital or acquired, so it is not restricted to a single origin. It does not typically produce a large hypotropia in primary gaze, and it is not primarily an inferior oblique issue. The hallmark is elevation deficit with the eye in adduction.