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.