Sequential Presentation of Bilateral Brown Syndrome: Report of a Case with an Interesting Imaging Finding

To present a case of bilateral Brown syndrome who presented as a unilateral disease and then showed the disease in the fellow eye in an older age.

A4-year-old girl presented with congenital Brown syndrome of the left eye and underwent a superior oblique weakening procedure in that eye, but then developed Brown syndrome in the right eye which required two more surgeries on the right eye to attain an acceptable alignment.

Her orbital computed tomography scan revealed that the distance between the annulus of Zinn and trochlea (Z‑T distance) was 41.2 mm in both sides, which was comparatively longer than her age‑ and sex‑matched cases. This finding can suggest a possible mechanism of Brown syndrome development in some patients.

Bilateral Brown syndrome can present as a sequential disease, and its radiologic finding may be associated with increased Z‑T distance.