brown - mclean syndrome ( bms ) is an infrequently diagnosed condition , defined by peripheral corneal edema that spares the center . clinically , bms is most often seen after cataract extraction but has been described after other surgeries as well ( e.g. , corneal transplantation ) [ 2 , 3 ] . nonsurgical insults such as lens subluxation [ 2 , 4 ] , angle closure glaucoma , myotonic dystrophy , and keratoconus   have also been described . here , his past ocular history was significant for bilateral congenital cataracts which required bilateral cataract extraction by phacoemulsification with posterior chamber intraocular lens ( pciol ) implantation at 2 months of age . there was no other relevant medical ( topical or systemic medication ) or surgical history . despite this intervention , the patient developed bilateral amblyopia and had severe nystagmus when either eye was occluded . at the time of presentation , his visual acuity was hand motion in both eyes . slit lamp examination of the right eye revealed a clear cornea with a fine pigmented line involving 360 degrees of the peripheral endothelium and a clear pciol . the left eye revealed normal conjunctiva , a clear central cornea with 360 degrees of peripheral stromal corneal edema with microbullae without epithelial defect , or vascularization , and a clear pciol ( fig . these findings were consistent with incipient bms in the right eye and established bms in the left eye . bms , first described in 1969 , is a condition defined by the presence of peripheral corneal edema with sparing of the central cornea . in its initial phase , a pigmented line on the peripheral endothelium may be seen . on progression , our patient 's findings were consistent with early bms in the right and more advanced disease in the left eye . one previous report described a 12-year - old girl with pigmented endothelial precipitates in the inferior peripheral cornea in the setting of congenital cataract removal 11 years earlier . however , the diagnosis of bms was not certain given the lack of corneal edema . bms typically occurs , on average , 17 years after surgery , with a widely published range of 1 month to 34 years [ 3 , 4 , 6 , 7 , 8 ] . a recent randomized , controlled study in 114 patients who underwent cataract extraction for congenital cataracts evaluated outcomes after lens implantation versus no lens implantation . overall , complications were low . with regard to corneal edema , no patients in the aphakia group and 1 patient in the iol group developed central corneal edema that lasted more than 30 days . the pathophysiology , which leads to peripheral corneal edema as opposed to central changes , is still unclear . bms has been thought to be associated with altered dynamics of the iris and aqueous that can occur after surgery and/or trauma . bms may have a genetic influence as it was reported in three members of an extended family , with a strong family history of low vision and ruptured tendons . it has also been reported in two pairs of sisters , one pair of which had marfan syndrome . interestingly , the condition is typically stable without progressive central corneal decompensation , and , therefore , patients usually remain asymptomatic . although specular microscopy may be performed to monitor the condition , it may not predict the clinical course , as the central cornea usually remains transparent , even when the central cell density is low . however , transient central edema associated with increased intraocular pressure , foreign body sensation , infectious keratitis , bullous keratopathy , and corneal endotheliitis in patients with bms has been reported . as our patient was asymptomatic , at this stage , our plan is to observe him . however , prior reports of patients with bms described various treatments to alleviate ocular surface discomfort including topical corticosteroids , hypertonic solutions , and/or therapeutic contact lenses . other reported options include stromal micropuncture of the peripheral cornea and annular amniotic membrane transplantation [ 12 , 13 ] . in summary , our case highlights that bms may develop in children as well as in adults . all children who undergo ocular surgery or experience ocular trauma should be monitored on a regular basis for the development of this and other potential ocular complications .