I read with enthusiasm the excellent case series on pediatric Horner syndrome reported by Bacal and Levy.1 Young children with anisocoria are always a management dilemma because most cases are benign in nature but rarely a diagnosis such as neuroblastoma is made. Once the word is uttered, many parents are terrified and want some type of imaging study performed. Unfortunately a magnetic resonance imaging study from nearly head to toe is required to search for all possible locations of a neuroblastoma mass, and this procedure may have significant morbidity in young children and infants. A simple office test to confirm that the anisocoria is not due to Horner syndrome is therefore a very helpful tool for parental reassurance. Conversely, confirmation that the diagnosis definitely is Horner syndrome can stiffen the ophthalmologist’s spine regarding the necessity for urine testing and radiologic studies. This report therefore has great clinical value.
Brown SM. The Utility of 0.5% Apraclonidine in the Diagnosis of Horner Syndrome. Arch Ophthalmol. 2005;123(4):578. doi:10.1001/archopht.123.4.578-a