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Title

Brown’s syndrome after blepharoplasty

Purpose	To call attention about acquired Brown’s syndrome as a potential oculomotor complication of cosmetic upper eyelid blepharoplasty.
Methods	Case report of a 62-year-old man who underwent a four eyelids blepharoplasty under local anesthesia. At first postoperative day, vertical binocular diplopia on right upgaze was reported. Oculomotor examination and Lancaster test favoured the diagnosis of a left acquired Brown’s syndrome. Orbital MRI was not contributive. Corticoid injection in the supero-nasal region of the left orbit failed to resolve diplopia that still persists 6 years after blepharoplasty.
Results	Acquired Brown’s syndrome has rarely been reported as a complication of upper lid blepharoplasty. Cadaver dissection showed that the potential mechanism is a too deep medial lid dissection, allowing damage to the trochlea or superior oblique tendon.
Conclusion	Upper lid surgery involving the medial part of the eyelid may lead to permanent Brown’s syndrome and crippling diplopia. Surgery in this area should be done with care, keeping in mind the anatomical landmarks of the trochlea and superior oblique tendon. Both the surgeon and the patient should be aware of this potential complication.

Authors 1

Last name	ALAMI
Initials	A
Department	Hôpital Erasme, Cliniques Universitaires de Bruxelles, ULB
City	Bruxelles

Authors 2

Last name	CORDONNIER
Initials	M
Department	Hôpital Erasme, Cliniques Universitaires de Bruxelles, ULB
City	Bruxelles