All of the following clinical findings are seen in Horner’s syndrome, Except:
Correct Answer: Apparent Exophthalmos
Description: Answer is D (Apparent Exophthalmos): Homer's Syndrome is associated with 'Apparent Enophthalmos' and not 'Apparent Exophthalmos' Apparent Enophthalmos may be seen in Horner's syndrome Horner's syndrome may be associated with apparent enophthalmos as a result of a narrow palpebral fissure, an appearance that the affected eye is located deeper (sunken in) compared with the unaffected eve. Heterochromia of iris may be seen in Horner's syndrome Heterochromia refers to a difference in the colour of iris between the two eyes. Homer's syndrome may be associated with 'sympathetic heterochromia'. Sympathetic heterochromia is characterized by pallor/progressive fading of the iris on the affected side (Hypochromic Heterochromia) and usually accompanies occulosympathetic paralysis that is sustained early in life (before age 2) (Congenital Horner's Syndrome). Progressive Heterochromia from acquired Homer's syndrome in adults is rare. Anhidrosis and Miosis are classical features of Horner's Syndrome Anhidrosis (ipsilateral facial anhidrosis) is one of the classical features of Homer's Syndrome seen in lesions of sympathetic pathway below the bifurcation of the carotid aery. Miosis and Ptosis are the other typical features of Horner's Syndrome Clinical. Finding In Horner's Syndrome Classical Triad * Miosis * Ptosis * Anhidrosis Note: Anhidrosis is absent in lesions at the level of internal carotid aery or above sudomotor and vasomotor fibers to the face follow the external carotid aery at the bifurcation. Other Signs of Horner's Syndrome Apparent Enophthalmos (d/t narrow palpebral fissure) Anisocoria Heterochromia of iris Dilation lag (slow dilation of pupil after lights are dimmed) Increased accommodative amplitude or accommodative paresis Transient ocular Hypotonia and conjunctival Hyperemia Horner's Syndrome from lesion of sympathetic Pathway Horner's syndrome from lesion of sympathetic pathway below bifurcation of carotic aery above bifurcation of carotid aery * Ptosis * Miosis * Anhidrosis * * Ptosis Miosis (Anhidrosis is absent) Clinical Findings in Homer's Syndrome (Taken from Localization in Clinical Neurology (Lippincott Williams) 2011/208: Ipsilateral mild (usually < 2 mm) ptosis (due to denervation of the Muller's muscle of the upper eyelid) Reverse Ptosis or 'Upside down ptosis' (due to sympathetic denervation to the lower eyelid retractors) Apparent enophthalmos Miosis Anisocoria due to ipsilateral miosis Dilation lag (slow dilation of the pupil after lights are dimmed) Increased accommodative amplitude or accommodative paresis (Patients hold the near card closer to read) Transient (acute phase) ocular hypotony and conjunctival hyperemia Heterochromia of the iris Variable ipsilateral facial anhidrosis Ipsilateral straight hair in some congenital cases (usually congenital but rarely acquired) Rarely neurotrophic corneal endothelial failure with pain and stromal edema (rare). Ipsilateral nasal obstruction with contralateral rhinorrhea with infantile cases (rare).
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