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

• Trauma
• Tumor

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:

Cocaine
Amphetatine

• 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