Juvenile idiopathic arthritis-associated uveitis complicated by glaucoma and Brown’s syndrome

Tejada, Pilar; Enríquez, Eugenia; Valle, José María Rodríguez del; Barceló, Anna; Gutiérrez, E.; Arocena, Jaime de Inocencio

doi:10.1093/rheumatology/kes069

Cited by 4 publications

(3 citation statements)

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“… 10 – 13 The underlying pathogenesis of Brown syndrome in these immunological disorders is not fully understood; however, most theories suggest a deposition of autoimmune complexes in the synovial membranes and tendon sheaths causing tenosynovitis and thickening of the tissues surrounding the superior oblique muscle tendon, impairing its movement within the trochlea and causing the hallmark picture of limited elevation on adduction. 14 , 15…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] The underlying pathogenesis of Brown syndrome in these immunological disorders is not fully understood; however, most theories suggest a deposition of autoimmune complexes in the synovial membranes and tendon sheaths causing tenosynovitis and thickening of the tissues surrounding the superior oblique muscle tendon, impairing its movement within the trochlea and causing the hallmark picture of limited elevation on adduction. 14,15 The Oxford-AstraZeneca COVID-19 vaccine has first been approved for use in the UK vaccination program in December 2020, followed by the European Medicines Agency, the Australian Therapeutic Goods Administration, and the World Health Organization in early 2021. The vaccine uses an altered adenoviral vector vaccine to induce an immune response against SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 99%

“…Although it may be idiopathic in some cases, a wide range of causes have been implicated including trauma to the superior or nasal orbital walls, glaucoma and scleral band surgeries, inflammatory and malignant sinus pathologies and surgeries, trochleitis, dysthyroid disease, and a myriad of rheumatological and immunological disorders such as enteropathic arthropathy, juvenile rheumatoid arthritis, rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome 10–13 . The underlying pathogenesis of Brown syndrome in these immunological disorders is not fully understood; however, most theories suggest a deposition of autoimmune complexes in the synovial membranes and tendon sheaths causing tenosynovitis and thickening of the tissues surrounding the superior oblique muscle tendon, impairing its movement within the trochlea and causing the hallmark picture of limited elevation on adduction 14,15 …”

Section: Discussionmentioning

confidence: 99%

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Case Report: Acquired Brown Syndrome after COVID-19 Vaccination

Fayed

Rakha

2023

Optom Vis Sci

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SIGNIFICANCE Brown syndrome, or superior oblique tendon sheath syndrome, is characterized by limitation of elevation on adduction. The disorder is thought to involve the trochlea/superior oblique tendon complex through traumatic, surgical, and inflammatory mechanisms. It could be an indication of multiple underlying immunological or rheumatological disorders. PURPOSE This study aimed to report an unusual strabismus after receiving the first dose of a live attenuated coronavirus disease 2019 (COVID-19) vaccine. CASE REPORT A 31-year-old female patient presented with painful vertical diplopia and tenderness of the left trochlear area 3 days after the first dose of COVID-19 vaccination. She had a compensatory chin elevation and face turn to the right, as well as a left 10-prism-diopter hypotropia in the primary position, which increased to 15 prism diopters in the right gaze and disappeared in the left gaze. Ocular motility revealed the limitation of elevation on adduction. The patient denied any history of ocular trauma and was consequently investigated for dysthyroid disease and various immunological and rheumatological disorders, which were excluded. A Hess chart was obtained to document the motility disorder. CONCLUSIONS We report a case of acquired Brown syndrome in a 31-year-old otherwise healthy woman shortly after COVID-19 vaccination. It is possible that the patient may have developed trochleitis and/or superior oblique tenosynovitis brought on by cross-reacting antibodies generated by the immune response to the vaccine. In the age of the widest vaccination campaign in human history, it is highly likely that we will continue to observe many unexpected potential adverse effects of these vaccines in our clinical practice.

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Section: Discussionmentioning

confidence: 99%