All the following are seen in Horner's syndrome EXCEPT (LQ)
Horner syndrome - (oculo sympathetic palsy)
Clinical Features q
1. Mild ptosis Q(usually 1-2 mm) as a result of weakness of Muller’s muscle
2. Slight elevation of the inferior eyelid as a result of weakness of inferior tarsal muscle,
3. MiosisQ - resulting from unopposed action of the sphincter pupillae, with resultant anisocoria which is accentuated in dim light, since the Horner pupil will not dilate, like its fellow.
4. Normal reactions to light and near
5. Reduced ipsilateral sweating (Anhidrosis), but only if the lesion is below the superior cervical ganglion i.e 1st order neuron because the fibers supplying the skin of the face run along the external carotid artery
6. *Slight enophthalmos Q (due to loss of tone of orbitalis muscle
7. Hypochromic - heterochromia (irides of different color-Horner is lighter) may be seen if the lesion is congenital
8. The pupil is slow to dilate
9. Dilatation Lag
10. Cocaine (4%) confirms the diagnosis – dilate Horner’s pupil
11. Hydroxyamphetamine (Paredrine) 1 % may be used to differentiate a preganglionic from a post ganglionic lesions
12. Adrenaline may also be used to assess denervation supersensitivity.