This is the chest X-ray of a smoker who presented with weight 
loss.

a. What does the chest X-ray show?

b. What ocular signs may be present?

c. If  b. were present, what would be the effect of topical 0.1%
adrenaline on the pupil?

Click here for the answers

This is the chest X-ray of a smoker who presented with weight loss.

a. What does the chest X-ray show?

There is a right apical lesion with destruction of the second and 
third ribs.The signs are typical of a neoplastic process in this case lung cancer. 

b. What ocular signs may be present?

Ipsilateral ptosis and small pupil (Horner's syndrome).
The presence of an apical lesion can cause Pancoast's tumour in which there is destruction of the lower brachial plexus (C8, T1 and T2) as well as the sympathetic ganglion producing ipsilateral Horner's syndrome.

c. If  b. were present, what would be the effect of topical 0.1% adrenaline 
    on the pupil?

No effect on the pupil. 
This is because the Horner's syndrome is caused by a preganglionic lesion. As such there is no denervation hypersensitivity as the post-ganglionic sympathetic nerve is intact and capable of secreting amide oxidase which rapidly break down the adrenaline.

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