Which of the following is NOT true regarding Brown's Syndrome?

• A. It may be acquired or congenital
• B. It is typically unilateral and characterized by a small hypotropia in primary gaze
• C. It is characterized by elevation deficits with adduction
• D. It is primarily an Inferior oblique issue

Answer: (D)

Brown’s syndrome is a mechanical restriction of upward eye movement when the eye is in adduction, caused by abnormal function or structure of the superior oblique tendon as it passes through the trochlea or its sheath. This leads to an elevation deficit specifically in adduction, rather than a general weakness of elevation in all gaze positions. The condition can be congenital or acquired and is often unilateral. In primary gaze you may see a small vertical misalignment (often a mild hypotropia of the affected eye), reflecting the limited ability to elevate when adducted.

The statement describing it as mainly an inferior oblique issue isn’t accurate because the problem lies with the superior oblique/trochlear complex, not the inferior oblique. The inferior oblique is an elevator in abduction; Brown’s syndrome involves restricted elevation in adduction due to superior oblique dysfunction, which is why the inferior oblique option is not the correct characterization.