A 56-year-old female patient with a 20-year old history of scleroderma was referred because of an emerging diplopia complaint. She has been found to have bilateral restriction of elevation on adduction. Magnetic resonance imaging revealed hyperintense signal changes on the anterior portion of superior and superonasal aspects of the orbits. She was assumed to have an inflammatory process resulting in stenosing tenosynovitis involving the superior oblique muscle and trochlea complex, which resulted in an acquired Brown syndrome. The patient responded well to local administration of corticosteroids.