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Brown's syndrome (Harold Whaley Brown)

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Fibrosis and shortening of the superior oblique tendon and attachment of the tendon sheath to the trochlea, resulting in restriction of eye movements. Palpebral fissure may widen when attempting upward gaze. Adduction and abduction restricted or abolished. Also associated with bilateral blepharoptosis, backward head tilt, and choroidal coloboma. Etiology unknown. Both sexes affected; present from birth.

New Scientist, 2 March 1996:

Conquering hero couldn’t see straight.
Arrogance may not have been the only reason that Alexander the Great went around with his nose stuck in the air. Doctors in Greece now believe that the characteristic pose of raised chin face turned to the right and neck tilting to the left as seen in most statues of the emperor - including those crafted by his personal sculptor Lysippos - may have been caused by a rare eye disorder.

Art historians have previously suggested that his posture had more to do with aspects of Alexander's personality - his «pride of youth» - rather than his true physical appearance. But in The Lancet (April, 1996) John Lascaratos and Alexander Damanakis from Athens University say he may have suffered from a rare paralysis in one of the muscles around his left eye, a condition known as Brown’s syndrome. In order to see straight, Alexander would have had to hold his head in exactly this position.

Brown’s syndrome can be inherited, or it can result from trauma. In this case, it is likely to have been caused by a wound sustained in battle. Alexander is known to have temporarily lost his sight at least once in combat. Brown’s syndrome is «as rare as hen’s teeth» says an ophthalmologist at London’s Western Eye Hospital.


  • H. W. Brown:
    Symposium I. St. Louis, Mosby, 1950: 205-236. Congenital structural motor anomalies in strabismus.
    In: J. H. Allen (ed) Ophthalmic Symposium, pp 205-229., St. Louis, CV Mosby, 1950. Isolated inferior oblique paralysis; an analysis of 97 cases.
    Transactions of the American Ophthalmological Society, Rochester, 1957, 55: 415-454.

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