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July 1983

Enophthalmos and Horner's Syndrome

Author Affiliations

Department of Neurology Rutgers Medical School Academic Health Sciences Center, CN 19 New Brunswick, NJ 08903

Arch Neurol. 1983;40(7):460. doi:10.1001/archneur.1983.04050070090034

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 authors3-4 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

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