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

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.