Horner Syndrome -CEW

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====== Horner Syndrome ======
  * Sympathetic dysfunction to the eye
    * Sympathetic innervation 
  * Clinical features: 
    * Anisocoria worse in dim light, smaller pupil doesn't dilate well (dilation lag)
    * Mild ptosis in the smaller pupil
    * Anhydrosis on the affected side
    * Heterochromia- less pigment on the affected side

=====Etiology=====
  * Trauma
  * Tumor

=====Clinical Testing=====
====Pharmacologic Testing====
**Apraclonidine**
  * Use in children >2-3 years due to risk of CNS respiratory depression
  * Measure pupils in bright and dim light
  * apply one drop in each eye
  * ReMeasure pupils in bright and dim light
  * Positive result: 
  * Negative (normal) result: 
  * See: 
**[[horner_syndrome_and_cocaine|Cocaine]]**\\
**[[cocaine_and_amphetamine_in_horner_syndrome|Amphetatine]]**
====CNS imaging====
===St. Luke's Imaging Protocol===
  * Order: MRI Brain with/without contrast, MRI neck soft tissue with and without contrast.  Put in notes of both "Suspect Horner syndrome", "Use Horner protocol" or something similar