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Show R r n w n S v n H r n m P A^ SnriafpH W i t h most cases are sporadic. Although Brown syndrome is usu- . . . ^^ i r • a% a n isolated finding, co- existence with crocodile tears, IVIOrninCj v j l O i y oyriQrOrnc congenital ptosis, Marcus Gunn syndrome, and coloboma of A 4- year- old girl presented with a left esotropia that & e c h o r o i d h a s b e e n reported ( 2). In a study of the trochlear had been noted by her parents since birth. There was no region ™ t h e f e t u s a n d embryo, Sevel ( 3) proposed that family history of ocular disease or of maternal drug use persistence of thickened embryological trabeculae might during pregnancy. Visual acuity was 20/ 20 OD and hand result in Brown syndrome. movements OS. She had a left esotropia of 16 prism diop- Morning glory syndrome is a rare congenital anomaly ters, a deficiency of elevation- in- adduction, and an ocular of t h e ° Pt ic disc> including an enlarged and excavated papilla down shoot in adduction bilaterally, findings considered with a n elevated peripheral pigmented choroid and a spoke-classic for Brown syndrome. She also had bilateral superior ^ arrangement of retinal vessels emerging at the disc oblique overaction ( Fig. 1). Ophthalmoscopy was normal margin. Most cases are unilateral, and visual acuity is usually ,-.-. . . . 1 J J , • •„ . j. poor in the affected eye. The etiology of the anomaly is OD and snowed an enlarged and excavated papilla with an r ,. • •, „ , t , . , , . , . . •. . ..-. unknown, and no hereditary tendency is evident. Usually an elevated peripheral pigmented choroid and a spoke- like ar- . , , J , , , , . , , . , ,. . isolated anomaly, some cases have also had persistent rangement of retinal vessels emerging at the disc margin , , A. ... , , v , ^_, , . „ ,. . • , , / r.- T. N hyperplastic vitreous, ciliary body cyst, congenital cataract, OS, the classic findings of morning glory syndrome ( Fig. 2). A - AV • e • 1 A e * i, u 1 ui 1 ' b . ,, , ,• • , and midline craniofacial defects such as basal encephalocele, Brown syndrome is caused by an abnormality in the u _* i • i a r J I * • au J J J hypertelorism, cleft lip and palate, or agenesis of the corpus superior oblique tendon- trochlea complex. Forced duction ^ ^ The a s s o c i a t i o n w i t h m i d l i n e crani0facial anorn-testrng is required to confirm the diagnosis, but lack of a] ies h a s b e e n a t t r i b u t e d to a developmental defect in cooperation makes it difficult to perform this test in very embry0genesis during the second gestational month ( 4). young patients. In these patients, it can be diagnosed based ^ a r e p o r t o f D u a n e retraction syndrome, another on the typical poor elevation- in- adduction with the largely sporadic ocular motility disorder, which was associ-frequently associated down shoot of the affected eye in ated with morning glory syndrome ( 5), the authors speculated adduction. An overacting superior oblique has been noted that a disturbance in embryogenesis at about two months of in some cases ( 1). The syndrome is usually unilateral and gestation was responsible for that rare association, congenital but may be acquired. In congenital form, the This case appears to be the first report of the associ-etiology is unclear. Familial occurrence has been noted, but ation of Brown syndrome and morning glory syndrome. Further studies are required to determine whether the association is merely coincidental. Suhan Tomac, MD Department of Ophthalmology Zonguldak Karaelmas University Faculty of Medicine Zonguldak, Turkey suhtomac@ yahoo. com REFERENCES 1. Kaban TJ, Smith K, Orion RB, et al. Natural history of presumed congenital Brown syndrome. Arch Ophthalmol 1993; 111: 943- 6. 2. Wilson ME, Eustis HS Jr, Parks MM. Brown's syndrome. Surv Ophthalmol 1989; 34: 153- 72. 3. Sevel D. Brown's syndrome: a possible etiology explained embryo-logically. J Pediatr Ophthalmol Strabismus 1981; 18: 26- 31. 4. Eustis HS, Sanders MR, Zimmerman T. Morning glory syndrome in children: association with endocrine and central nervous system anomalies. Arch Ophthalmol 1994; 112: 204- 7. 5. Kawano K, Fujita S. Duane's retraction syndrome associated with morning glory syndrome. J Pediatr Ophthalmol Strabismus 1981; 18: 5 1 ^ . |