“Pediatric Brown syndrome in the setting of hypercholesterolemia: case report of a possible new association”

<i>Introduction and clinical importance</i>: Brown Syndrome is a form of vertical strabismus characterized by limitation in elevation of the eye in the adducted position, main pathology attributed to superior oblique tendon-trochlear complex, which can either be congenital or acquired, secondary to trauma, inflammation, or iatrogenic in nature. <i>Case Presentation</i>: A 7-year-old male presented for a routine checkup to the out-patient department and upon clinical examination showed a limitation of extraocular movement of the right eye in adduction in elevation, with no deviation in primary gaze. On slit lamp examination, arcus juvenilis was observed in both the eyes with no other observable ocular abnormalities. A blood workup revealed highly deranged lipid profile levels and a diagnosis of familial hypercholesterolemia was made after pediatric medicine evaluation. <i>Clinical discussion</i>: Brown syndrome is an uncommon eye disorder, typically characterized by a restriction of movement in the direction of movement of superior oblique tenson, leading to inability in moving the affected eye superiorly, particularly in the adducted position. Acquired Brown syndrome can be due to a number of systemic diseases, such as dysthyroidism, rheumatoid arthritis, systemic lupus erythematosus, and many more. However, an association between dyslipidaemia or hypercholesterolemia has not been mentioned in literature. <i>Conclusions</i>: Brown syndrome and familial hypercholesterolemia encountered in our patient could either be a coincidental finding or could be an association which has yet to be explored. Lack of any preexisting literature highlights the need to explore more on this frontier.