If you noticed ptosis, answer the following questions:
1-is ptosis complete or partial
2-is it unilateral or bilateral
3-is the pupil constricted ->Horner’s syndrome
Dilated->3rd nerve palsy
4-are extra ocular muscles involved?
5-is the eyeball sunken or not (enophthalmos)
6-is the light reflex intact (intact light reflex in Horner’s)
If the patient has Horner’s syndrome then proceed as follow:
Examine the supraclavicular area
Look for scar of cervical sympathectomy
Look for enlarge lymph nodes
Percuss for dullness (pancoast tumour)
Examine the neck
Carotid and aortic aneurysm
Tracheal deviation
Examine the hands
Small muscle wasting
Sensation
Clubbing
Ask about loss of sweating on one side of the face.
Look for evidence of brain stem vascular disease or demyelination
presentation:
this patient has miosis,enophthalmos and left ptosis.
this is left Horner's syndrome.
what is Horner's syndrome?
Horner syndrome results from an interruption of the sympathetic nerve supply to the eye, and is characterized by the classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis).
Horner syndrome isn't a disease but a sign of an underlying — often serious — disorder
what are the causes of Horner's syndrome?
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