Brown's Syndrome (acquired) and lightheadedness/losing focus

I'm a 33 year old male with acquired Brown's Syndrome. I had surgery
for a 'lazy eye' when I was in the 2nd grade, though I can't recall
which eye it was; they ended up operating on both eyes.

When I was about 24 or 25 I developed a slowly progressing nodule of
some in the muscle of my left eye next to the nose/brow point. My eye
would 'pop' past this nodule, but eventually it stopped doing that.
(I could also manipulate the eye past the nodule.) I eventually saw a
doctor who called it Brown's Syndrome and theorized that it was
probably a combination of scar tissue from my childhood surgery and
possible aggravation from constantly having my head lowered over a
keyboard while looking up and to the right at my computer monitor
(something I did at the time for - no joke - about 12 hours per day
and have continued to do to this day). I was told it might go away on
its own, but that unless it presented a real problem it did not need
surgery. Eventually I seem to have adjusted to the double vision
caused when looking up and to the right at an object, and today though
I can still 'force' the double vision it doesn't seem to happen as
readily.

The problem is that I constantly feel just the slightest pressure in
the corner (nasal/brow) of my eye there, and that pressure seems to be
getting a bit worse. I don't know whether it's pressure or strain,
it's that vague feeling. More importantly over the last few months
I've been noticing that I seem to lose focus when scanning back and
forth for text, or when moving my eyes rapidly to something a few feet
away from whatever I was concentrating on. There's this fleeting,
lightheaded 'whoa' kind of feeling and I can almost feel the muscles
around my eyes (and even a sensation into the area between my eyes)
sort of freak out for just a moment when this happens as I regain the
focus. This does not happen when I have the left (affected) eye
covered, in fact I generally feel curiously stable with the left eye
covered.

Is it possible that over time this muscle has gotten weaker, or that
the strain of the problem has thrown other muscles around the eye off,
and this is beginning to affect my eyes' ability to work together?
Could this be creating these fleeting problems where I momentarily
seem to lose focus and sometimes as a result my sense of position?

 

In short, all the conclusions at the end you reached are possible. The
childhood surgery probably has nothing to do with it. It is generally
inflammatory cause for the nodule on the superior oblique tendon. Rarely,
local injection of steroids can help, but usually only for acute nodules.

You know the joke about the patient who goes to the doctor and says it hurts
only when he does some stange contortion, and the doctor answers by telling
him not to do that? Same here: mode your onitor to the other side. Stop
irritating it all the time - you are just asking for more trouble.

DON'T LET ANYONE OPERATE on it unless no other resort: the act of weakening
(cutting) the tendon can predispose you to torsional diplopia, and problems
in reading position.


David Robins, MD
Board certified Ophthalmologist
Pediatric and strabismus subspecialty
Member of AAPOS
(American Academy of Pediatric Ophthalmology and Strabismus)