Right congenital Honer's syndrome with anisocoria.
Left Horner's syndrome.
Right Horner's sydrome.
The patient has a slight right ptosis with ipsilateral miosis(you may need to shield the eyes or dim the light to accentuate the anisocoria). There is an apparent right enophthalmos. Additional signs (which may be difficult to detect) are anhydrosis and vasodilation of head and neck if the lesion were pre-ganglionic.
Look for the cause:
- difference in eye colour in congenital Horner's syndrome (as in this case, the right eye is lighter than the left)
- neck scar as in thryoidectomy
- wasting of ipsilateral hand muscles due to brachial plexus lesion as in Pancoast's tumour
- scars below the claivcle from sympathetomy for Raynaud's disease (this is an out-dated treatment)
1. What is the cause enophthalmos in Horner's syndrome?