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Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MIDepartment of Neurology, University of Michigan, Ann Arbor, MI
Correspondence to Rajesh C. Rao, MD, Department of Ophthalmology, University of Michigan Medical Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MIRogel Cancer Center, University of Michigan, Ann Arbor, MIDepartment of Pathology, University of Michigan, Ann Arbor, MIDepartment of Human Genetics, University of Michigan, Ann Arbor, MIA. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, MISection of Ophthalmology, Surgery Service, Veterans Administration Ann Arbor Health System, Ann Arbor, MI
A 55-year-old woman reported, since infancy, right-sided ptosis (Fig. 1A,1B), anhidrosis, exertional pallor (Fig. 1B), and lightly pigmented iris with miosis (Fig. 1C vs 1D). There was no history of birth trauma, malignancy, or vascular abnormality. Examination
was otherwise normal other than a reversal of anisocoria with apraclonidine (before
apraclonidine administration: Fig. 2A; after apraclonidine administration: Fig. 2B). These features indicate congenital Horner's syndrome, in which sympathetic innervation
controlling Müller's muscle of the eyelid, iris dilator muscles, iris pigmentation,
sweat glands, and vasomotor activity is disrupted. Ipsilateral anhidrosis implies
a pre-superior cervical ganglionic lesion. Unlike acquired Horner's syndrome, congenital
Horner's syndrome is generally a benign, idiopathic entity that does not require routine
imaging beyond examination during infancy to exclude masses along the sympathetic
chain.
Figure 1Right-sided ptosis (A, B), anhidrosis, exertional pallor (B), and lightly pigmented
iris with miosis (C vs D).
