Acquired Intermittent Superior Oblique Tendon Sheath Syndrome (SOTSS): Three Case Reports

M.Stamos

Three cases of acquired, intermittent, unilateral Superior Oblique Tendon Sheath Syndrome (SOTSS) or Brown’s Syndrome are presented. They presented with differing symptoms and on clinical assessment of ocular movements demonstrated a marked restriction, and at times, a complete absence of elevation in adduction of the affected eye – depicting a marked inferior oblique underaction. This abnormality of movement possible as a result of prevention of muscle movement through the trochlea was found to be due to a localized inflammation, possibly of the orbit in one case, a systemic disease in another, and of unknown cause in the third. The intermittent nature and ‘click’ phenomenon will be described and discussed.