Case Report: Acquired Brown Syndrome following COVID-19 Vaccination

Abstract

Significance 

Brown syndrome, or Superior Oblique Tendon Sheath Syndrome (SOTSS), 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 

To report an unusual strabismus after receiving the first dose of a live attenuated COVID-19 vaccine.

Case Report 

A 31-year-old female patient presented with painful vertical diplopia & 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 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 female 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 side effects of these vaccines in our clinical practice.