Idiopathic brow underaction

Dr Russell Watkins and Professor David Elliott describe a common condition about which there has been all too little concern among practitioners

Idiopathic brow underaction (IBU) is a condition where the patient is unable to raise their eyebrows to a normal degree. It is a fairly common condition, though underdiagnosed. In this report, we provide a brief introduction and review of the literature and present a case study.

Figure 2 - Subject with gross brow underaction of her right eye. Note the loss of normal muscle tone and absence of any sense of expression.

Case study and discussion
AF, a 30-year-old educational facilitator was noted to have a blunted facial expression during a routine optometric examination. During the case history, AF recounted how, over the last few months, she had noticed difficulties in 'connecting' with her classes. She had tried to reflect on her problems, but could not identify where the problem lay.

We instigated brow underaction reinforcement lessons using Steri-Strips (3M) attached to the brow and the junction between the outer two-thirds and inner third of the zygomatic arch (cheekbone). This position of the Steri-Strip provides the necessary resistance against lifting the brow, yet allows eye contact to be maintained. AF was instructed to perform brow lifting against resistance in an attempt to strengthen frontalis (Figures 2 and 3). This she carried out for one hour a day for one week. The next stage involved the exercise of emphasising a point using only the brow; the hands should be sat on for this part of the exercise. Again, one hour a day for one week was all that was required.