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
ARVO 2025: Anat Loewenstein, MD, shares data from herself and her colleagues on meeting needs of patients with diabetic retinopathy
At the American Society of Cataract and Refractive Surgeons annual meeting, Sheng Lim, MD, FRCOphth discusses the benefit of endoscopic cyclophotocoagulation for patients with primary open angle glaucoma and cataracts in the CONCEPT study
A photo of Seville, Spain, with the Congress on Controversies in Ophthalmology logo superimposed on it. Image credit: ©francovolpato – stock.adobe.com; logo courtesy COPHy
Anat Loewenstein, MD, Professor and Director, Department of Ophthalmology, Tel Aviv Medical Center, discusses the Congress on Controversies in Ophthalmology (COPHy)
Anat Loewenstein, MD, speaks about the 22nd Annual Angiogenesis, Exudation, and Degeneration Meeting in February 2025 and shares her global forecast for AI-driven home OCT
Sarah M. Thomasy, DVM, PhD, DACVO, a veterinary ophthalmologist at UC Davis, talks about how her research at the Glaucoma 360 symposium
I. Paul Singh, MD, an anterior segment and glaucoma specialist, discusses the Glaucoma 360 conference, where he participated in a panel discussion on the use of artificial intelligence (AI) in glaucoma care.
Charles Wykoff, MD, PhD, discusses his Floretina ICOOR presentation topic, retinal non-perfusion in diabetic retinopathy, with David Hutton, editor of Ophthalmology Times
Elizabeth Cohen, MD, discusses the Zoster Eye Disease study at the 2024 AAO meeting
© 2025 MJH Life Sciences

All rights reserved.