Treatment of acquired Brown syndrome in a child with a single intramuscular systemic depot steroid injection.

A 10-year-old girl presented with a complaint of diplopia and mild superomedial orbital pain in the left eye of 2 weeks' duration. She had limited elevation of the left eye, especially in adduction, moderate limitation of elevation in the primary position, mild limitation of elevation in abduction, downshoot in adduction, mild hypotropia in the primary position, and normal abduction. There was mild swelling and tenderness in the superomedial aspect of her left orbit. Fundus examination revealed intorsion of the left fundus on upgaze. She was diagnosed with acquired Brown syndrome, due presumably to a local inflammatory cause, and treated with a single intramuscular depot injection of betamethasone in her deltoid muscle. One week later, her symptoms were resolving, and there was marked improvement of elevation of the left eye in adduction, with near normal elevation in the primary position and in abduction. There was no recurrence 3 months later.