Manual

Horner syndrome

Neuro-Ophthalmology

Horner syndrome

Ptosis, miosis, ± anhidrosis.

  • Anisocoria greater in the dark with dilation lag; mild ptosis with lower-lid reverse ptosis.
  • Confirm: apraclonidine 0.5% reverses anisocoria (Horner pupil dilates) or cocaine fails to dilate it.
  • Painful acute Horner = carotid dissection until proven otherwise → CTA/MRA head and neck emergently.
  • Children: congenital (iris heterochromia) or neuroblastoma — check urine catecholamines and imaging.
NextCN III, IV and VI palsies

Educational summary — follow local protocols and current guidelines.