Karadžić Jelena, Kovačević Igor, Ljikar Jelena
Srp Arh Celok Lek. 2016 May-Jun;144(5-6):312-4.
Horner’s syndrome is an interruption of the sympathetic nervous system at any point along its course between the hypothalamus and the orbit. Horner’s syndrome is classically presented as an ipsilateral miosis, subtle ptosis, and facial anhidrosis. Pharmacologic testing is very useful in the diagnosis of Horner’s syndrome as it could help to localize the lesioned neuron in the sympathetic pathway, suggesting an etiology.
We present a case report of a 41-year-old woman who reported right eyelid drooping immediately after operation of sympathetic chain schwannoma. We performed apraclonidine test for the diagnosis of Horner’s syndrome, which produced mydriasis on the affected eye, while there was no significant change of the normal eye. Based on the clinical presentation of anisocoria and one-sided ptosis, and previous medical history of surgical removal of the mediastinal tumor, the patient was diagnosed with a right-sided, partial Horner’s syndrome.
Timely recognition, exact localization of the lesioned neuron, and referral for urgent imaging studies are important for ophthalmologists in order to prevent and treat life-threatening conditions. Besides its diagnostic value in Horner’s syndrome, topical apraclonidine could correct ptosis for the sake of esthetics or when ptosis reduces the superior visual field.
霍纳综合征是指交感神经系统在从下丘脑至眼眶的行程中任何部位受到阻断。霍纳综合征的典型表现为同侧瞳孔缩小、轻度上睑下垂和面部无汗。药理学检测对霍纳综合征的诊断非常有用，因为它有助于定位交感神经通路中受损的神经元，从而提示病因。
我们报告一例41岁女性病例，该患者在交感神经链神经鞘瘤手术后立即出现右眼睑下垂。我们进行了阿可乐定试验以诊断霍纳综合征，结果患侧眼睛出现瞳孔散大，而健侧眼睛无明显变化。基于双眼瞳孔不等大及单侧上睑下垂的临床表现，以及既往纵隔肿瘤手术史，该患者被诊断为右侧部分性霍纳综合征。
对于眼科医生而言，及时识别、准确确定受损神经元的位置并转诊进行紧急影像学检查对于预防和治疗危及生命的疾病很重要。除了在霍纳综合征中的诊断价值外，局部使用阿可乐定还可出于美观考虑或当上睑下垂导致上方视野缩小时纠正上睑下垂。
