Brown syndrome is an ocular motility disorder characterized by limited elevation in adduction. The
congenital form of Brown syndrome is thought to occur due to anomalies of the superior oblique (SO)
tendon or of the trochlea. The diagnosis of Brown syndrome is essentially clinical. The limitation in
adduction and the positive forced duction test are the consistent features to diagnose Brown’s
syndrome. This patient exhibits, limitation of elevation on adduction that improved in abduction;
widening of the palpebral fissure on adduction; and a positive forced duction test. The atypical features
that made this case unique are a large hypertropia in the contralateral eye with a large constant
exotropia and absence of AHP. It can be explained that congenital ocular motility disorders if not
assessed and surgically corrected at younger age may cause variable symptoms depending on the
severity. Bilateral LR recession and SO tenotomy in the right eye was performed, achieving
satisfactory alignment with one surgical procedure