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:

Cocaine
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