Pharmacologic testing, to confirm the diagnosis of a Horner's syndrome: Occasionally anhydrosis of the face will also be seen. There is ipsilateral ptosis due to paresis of Muller's muscle (not the levator muscle of the eyelid) There is an pseudo enophthalmos because of the associated ptosis. Lesions of the sympathetic system cause a small pupil Horner's Syndrome Horner's Syndrome, consists of pupillary miosis which is more accentuated in darkness. Pupils that “accommodate to near objects but do not react to light are said to show light-near dissociation.They are a highly specific sign of neurosyphilis.The accommodation pathways (pathways to the Edinger-Westphal nucleus that cause the pupils to constrict with near vision) are thought to be spared because of their more ventral course in the brainstem. These light-sensitive pathways allow the pupil to constrict to bright light. Specifically caused by selective damage to pathways from the retina to the Edinger-Westphal nucleus. The primary lesion is thought to be caused by damage to central pathways for pupillary constriction.They were formerly known as "prostitute's pupils" because of their association with syphilis and because, like a prostitute, they “accommodate but do not react. Bilateral small pupils that constrict when the patient focuses on a near object, but do not constrict when exposed to bright light (they do not “react” to light).Caused by damage to peripheral pathways to the pupil (parasympathetic neurons in the ciliary ganglion Argyll Robertson pupils.The lesion causing pupillary dysfunction is generally thought to be in the ciliary ganglion and the cause is basically unknown Adie's syndrome consists of a tonic pupil and loss of deep tendon reflexes. Because the abnormality is post-ganglionic (that is, damage to the ciliary ganglion), one can demonstrate supersensitivity of the sphincter muscle to pilocarpine 1/10%. Under the slit lamp sectoral palsies of pupillary sphincter may be seen with light stimulation.Characterized by a dilated pupil with very poor or no light reaction with tonic constriction to near and tonic redilation.An isolated dilated pupil does not usually signify a III nerve palsy. ![]()
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