Bilateral Brown's syndrome with Parry-Romberg syndrome: frozen gaze and fading face.

Abstract

Purpose: We report a rare case of bilateral Brown's syndrome associated with Parry-Romberg Syndrome (PRS), highlighting this rare syndromic association and its possible shared pathophysiology. Methods: An 8-year-old female presented with longstanding right-eye inward deviation and decreased vision in the right eye. Ocular examination revealed bilateral limitation of elevation in adduction, consistent with Brown's syndrome. Systemic findings included progressive right-sided facial atrophy, preauricular skin anomalies, and dental abnormalities. Imaging and laboratory investigations confirmed PRS. Surgical management and ongoing follow-up outcomes were documented. Results: Forced duction testing demonstrated bilateral superior oblique tightness. Imaging revealed generalized extraocular muscle atrophy with relative fibrosis of the superior obliques. The patient underwent right eye superior oblique tenotomy and 5 mm medial rectus recession under general anesthesia. Postoperatively, ocular alignment improved significantly, with residual 5 prism diopters of hypotropia in primary gaze. Multidisciplinary evaluation confirmed PRS, and amblyopia therapy was initiated with ongoing follow up for progressive facial changes. Conclusion: This is a rare reported case of bilateral Brown's syndrome associated with PRS. This case broadens the ophthalmic spectrum of PRS and suggests a potential link between progressive hemifacial atrophy and restrictive strabismus patterns. Comprehensive ophthalmic and systemic evaluation is essential in such complex presentations.