Purpose: Brown syndrome refers to limited elevation in adduction due to abnormal function of the superior oblique tendon-trochlea complex, which may be congenital or acquired. Acquired causes include iatrogenic, traumatic, neoplastic, infectious and inflammatory processes, or rarely, idiopathic if a thorough work up is unrevealing. The aim of this poster is to present the rare case of a bilateral idiopathic acquired Brown syndrome of simultaneous onset, and its subsequent management and outcome.

Method: Case report of a 13 year old boy who presented with acute onset painful binocular diplopia with examination including forced duction testing consistent with an acute bilateral Brown syndrome (photos included). Old photographs demonstrated there was no history of prior strabismus. Extensive work up, including blood tests, MRI, electromyography was unrevealing, and thus an idiopathic aetiology was presumed.

Results: Our patient received a course of oral corticosteroids followed by two treatments of bilateral intra-trochlear triamcinolone injections with no improvement. The option of surgery was proposed but at the parents' request a conservative approach was eventually adopted. Twelve months later his strabismus was unchanged.

Conclusion: To the best of our knowledge there have been no cases of a bilateral idiopathic acquired Brown syndrome with simultaneous presentation published in the literature to date. Idiopathic Brown syndrome has been reported to respond to steroids or occasionally recover spontaneously, however this did not occur with our case.