Moorfields Eye Hospital, London, UK.
Eye (Lond). 2013 Mar;27(3):291-8. doi: 10.1038/eye.2012.281. Epub 2013 Feb 1.
The diagnosis of Horner's syndrome (HS) can be difficult, as patients rarely present with the classic triad of ptosis, miosis, and anhydrosis. Frequently, there are no associated symptoms to help determine or localise the underlying pathology. The onset of anisocoria may also be uncertain, with many cases referred after incidental discovery on routine optometric assessment. Although the textbooks discuss the use of cocaine, apraclonidine, and hydroxyamphetamine to diagnose and localise HS, in addition to reported false positive and negative results, these pharmacological agents are rarely available during acute assessment or in general ophthalmic departments. Typically, a week is required between using cocaine or apraclonidine for diagnosis and localisation of HS with hydroxyamphetamine, leaving the clinician with the decision of which investigations to request and with what urgency. Modern imaging modalities have advanced significantly and become more readily available since many of the established management algorithms were written. We thus propose a practical and safe combined clinical and radiological diagnostic protocol for HS that can be applied in most clinical settings.
霍纳综合征（HS）的诊断可能较为困难，因为患者很少出现上睑下垂、瞳孔缩小和无汗三联征。通常，没有相关症状可以帮助确定或定位潜在的病理。瞳孔不等大的发作也可能不确定，许多病例是在常规眼科评估中偶然发现后转诊的。尽管教科书讨论了使用可卡因、阿可乐定和羟苯丙胺来诊断和定位 HS，以及报告的假阳性和假阴性结果，但在急性评估或一般眼科部门中，这些药物很少使用。通常，使用可卡因或阿可乐定进行诊断和定位 HS 后，需要一周时间才能使用羟苯丙胺，这使得临床医生需要决定请求哪些检查以及以多快的速度进行检查。自从许多既定的管理算法被编写以来，现代成像方式已经取得了显著进展，并且更容易获得。因此，我们提出了一种实用且安全的霍纳综合征综合临床和影像学诊断方案，可在大多数临床环境中应用。
