Late recurrence of idiopathic Brown's syndrome successfully treated with oral corticosteroids

Introduction: Idiopathic Brown's syndrome is a restrictive strabismus of the superior oblique tendon that often presents in pediatric populations and rarely occurs in adults. Case description: We present here a case of a 41-year-old man with an idiopathic left Brown's syndrome that recurred after presenting with similar symptoms 14 years prior that was originally treated with oral corticosteroids. This patient had a negative work up for connective tissue disease and only exhibited subtle left trochlear thickening on orbital MRI with contrast. Since he had a good response to oral corticosteroids in the past, this repeat occurrence was treated with oral Prednisone and he promptly responded. His double vision resolved within 2 weeks and he continued to have a normal examination 6 months after presentation. Conclusion: We suspect this case was related to a subclinical inflammatory process resulting in the MRI findings and response to steroids. This case demonstrates that idiopathic Brown's syndrome can recur more than a decade later in adults and oral corticosteroids are an effective treatment option even in the absence of an underlying rheumatological condition.