Corneal Topography Analysis in Establishing the Pathophysiologic Mechanism of Cyclic Brown's Syndrome Strabismus. A Case Report.

Purpose: To evaluate the responsible pathophysiological mechanism in a 15 year old patient with acquired Browns Syndrome presenting with cyclic characteristics.

Methods: In addition to a full orthoptic assessment, magnetic resonance imaging of the orbit, corneal topography and computerized videokeratography data analysis during the diplopic period, during resolution and following betamethasone injection into the trochlear region were accomplished.

Results: The MRI scan demonstrated enlargement of the tendon trochlea complex that was similar during the diplopic episode and resolution. The tendon trochlea complex revealed hyperintensity on T1 weighted sagittal images. At the time of resolution topographic examination revealed steepening of the 55 degree meridian. The patient received an injection of depot betamethasone into the trochlear region. Compared to the period of spontaneous resolution, a steeper 55 degree meridian was demonstrated on corneal topography following steroid injection. The patient was symptom free for more than a year after steroid injection.

Conclusion: The topographical findings and the relief of symptoms after steroid injection suggests a vascular etiology for the condition of Browns Syndrome in this particular case.