Acquired Brown Syndrome as a Postoperative Complication of Orbital Wall Fracture Repair with Metallic Mesh

<b>Background:</b> Surgical repair of orbital fractures comes with risks. One rare risk is interference with the actions of the superior oblique tendon-muscle complex causing an acquired Brown syndrome. We present the case of a 45-year-old man who developed acquired Brown syndrome after undergoing repair of a large orbital floor and medial orbital wall fracture using a titanium mesh implant. A case report was prepared to discuss a rare surgical risk with open reduction internal fixation (ORIF) of an orbital wall fracture. <b>Methods:</b> A retrospective chart review was performed. <b>Results:</b> Post-operative ophthalmological assessment revealed persistent diplopia along with limitations of up-gaze particularly in the adducted position. Ultimately, the patient underwent surgical repositioning of the orbital implant, which seemingly released the superior oblique muscle-tendon complex, resolving most of the diplopia. No further treatment with prisms or strabismus surgery has been required. <b>Conclusions:</b> Acquired Brown syndrome is a potential risk of surgical repair of orbital fractures involving the medial orbital wall. Herein this case study, we describe a case of acquired Brown syndrome following ORIF of an orbital floor and medial wall fracture, which was alleviated with a revision surgery.