When an eye is in adduction and the superior oblique muscle (SO) contracts, the eye depresses because the SO inserts posterior to the center of rotation. Conversely, when an eye with a normal SO elevates in adduction, the SO insertion moves posteriorly, pulling the SO tendon through the trochlea. If the SO is tight, it cannot pass through the trochlea due to swelling or anatomic variants or, possibly, if the insertion is anomalous the eye cannot elevate in adduction. This is the clinical manifestation of Brown syndrome.
Brown syndrome V-pattern
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