It's not all black and white

Article

In some cases, it can be difficult for ophthalmologists to determine precisely what is affecting their patient. It is essential that a correct diagnosis is established as a misdiagnosis could have serious consequences for the patient; allowing the real problem to progress undetected. Here, Arashvand and Geh talk us through a case of orbital injury mimicking traumatic Brown's Syndrome.

The case

Muscle entrapment after orbital fracture usually involves the inferior rectus, while solitary inferior oblique entrapment is uncommon. In this case, solitary inferior oblique entrapment clinically mimics Brown's syndrome.

A patient with traumatic Brown's syndrome is more likely to complain of pain in the region of the trochlea, while the elevation deficiency produced by a blow-out fracture is usually more marked in abduction rather than adduction.2

How do we treat it?

There is no consensus on the optimal treatment for blowout fractures. Some authors recommend early surgical therapy while others advocate surgery only when conservative therapy has been ineffective. Diplopia persists in a significant number of patients following surgical treatment of a blowout fracture of the orbital floor, even when surgery is performed within 15 days after the traumatic incident.3 Our patient was managed conservatively and, after eight weeks, his diplopia was resolved with full recovery of ocular motility (Figure 3).

The case clearly highlights how inferior oblique muscle entrapment in an orbital floor fracture can mimic Brown's syndrome. These restrictive conditions are very similar clinically; therefore, attention to the nature of injury and imaging study are crucial to differentiate these two circumstances.

Newsletter

Join ophthalmologists across Europe—sign up for exclusive updates and innovations in surgical techniques and clinical care.

Recent Videos
Christine Curcio, PhD, of the University of Alabama at Birmingham Heersink School of Medicine, shares histology update and revised nomenclature for OCT with Sheryl Stevenson of the Eye Care Network and Ophthalmology Times
SriniVas R. Sadda, MD, FARVO, shares key points from his retina presentation at the International SPECTRALIS Symposium
Robert Sergott, MD, describes fluorescence lifetime imaging ophthalmoscopy (FLIO) and the International SPECTRALIS Symposium – And Beyond (ISS) in Heidelberg, Germany.
Rayaz Malik, MBChB, PhD, a professor of medicine at Weill Cornell Medicine - Qatar, spoke with Ophthalmology Times Europe about his presentation. It's titled "An eye on neurodegenerative diseases: Challenging the dogma" at the International SPECTRALIS Sympsoium. In conversation with Hattie Hayes, Ophthalmology Times Europe
Anat Loewenstein, MD, describes her presentation on remote imaging for age-related macular degeneration and geographic atrophy at the International SPECTRALIS Symposium, in conversation with Hattie Hayes of Ophthalmology Times Europe
Tyson Brunstetter, OD, PhD, a US Navy Aerospace Optometrist at the NASA Johnson Space Center in Houston, Texas, shares key takeaways from his keynote at the International SPECTRALIS Symposium (ISS)
Rayaz Malik, MBChB, PhD, shares his presentation, titled An eye on neurodegenerative diseases: Challenging the dogma, at this year's International SPECTRALIS Symposium
At the Retina World Congress, Siegfried Priglinger, MD, speaks about ensuring the best outcomes for preschool-aged patients
At the 2025 ASCRS meeting, Robert Ang, MD said small aperture IOLs can benefit all patients, especially those with complex corneas or who have undergone previous corneal refractive surgery
Viha Vig, MBChB graduate student at the University of Auckland, New Zealand, discusses her poster presentation on the relationship between mitochondiral disease, Alzheimer disease, and other types of dementia.
© 2025 MJH Life Sciences

All rights reserved.