Hypertropia following Spontaneous Resolution of Brown's Syndrome

PURPOSE: To report a case of bilateral Brown's syndrome with unilateral spontaneous resolution causing hypertropia and significant head tilt. CASE REPORT: A 3 ½-year-old girl presented with bilateral typical Brown's syndrome and orthophoria in the primary position; she presented with unilateral resolution of right Brown's syndrome 6 months later, causing right hypertropia and gradually deteriorating left head tilt. She benefited from right superior rectus muscle recession to help correct her head posture. CONCLUSION: This is the first report of a patient presenting with known bilateral Brown's syndrome with subsequent documented unilateral resolution causing a significant hypertropia of the resolved side and contralateral head tilt. Our case provides evidence in support of Clark and Noël's [Can J Ophthalmol 1993;28:213–216] hypothesis that patients who present with unilateral Brown's syndrome and contralateral inferior oblique muscle overaction might originally have had bilateral Brown's syndrome with spontaneous resolution of 1 side only.