Enophthalmos and Horner's Syndrome

To the Editor.  —Although S. Weir Mitchell in 1864¹ and J. F. Horner in 1869² published the first descriptions of ipsilateral miosis, ptosis, anhidrosis, facial flushing, and enophthalmos attributed to interruption of ocular sympathetic innervation, some authors^3-4 have subsequently denied that enophthalmos is a reliable sign of Horner's syndrome, whereas others⁵ have affirmed its frequent presence. To help resolve the persistent question of whether there really is a measurable enophthalmos, I studied 14 patients with acquired unilateral Horner's syndrome.

Patients and Methods.  •The presence of Horner's syndrome was ascertained by miosis, anisocoria greatest in the first 5 s of decreased illumination, ptosis, upsidedown ptosis of the lower lid, varying degrees of anhidrosis, and impaired dilation in response to 10% cocaine, if indicated. Localization proximal or distal to the superior cervical ganglion was established by clinical history, radiologie study if appropriate, and pupillary response to 1% hydroxyamphetamine