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Christy Benson, Sarah Suh, Donny W Suh; The degree of anisocoria in pediatric patients with Horner syndrome when compared to children without disease. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):586. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To study the magnitude of anisocoria in pediatric patients using the plusoptiX A08 photoscreener as compared to pediatric patients with Horner syndrome to determine if anisocoria alone should raise suspicion for the diagnosis.
The medical records of 592 consecutive patients, neonates to nine years of age, were collected and analyzed. All patients had complete ophthalmologic examinations that included photoscreening with the plusoptiX A08. Data included age, pupil sizes, and degree of anisocoria. This was then compared with pupillary sizes of 32 pediatric patients with a known diagnosis of Horner syndrome.
Of the 592 children without Horner syndrome, 404 had anisocoria of ≤0.5 mm (68.13%), 167 had anisocoria of 0.6-1.2 mm (28.16%), and 21 had anisocoria of >1.3 mm (3.70%). There was no correlation between increasing age and severity of anisocoria (p=0.55). The average degree of anisocoria was 0.5 mm. For pediatric patients with a diagnosis of Horner syndrome, the average level of anisocoria in room light was 1.37 mm and 2.0 mm in darkness. In room light, 3 children had anisocoria of ≤0.5 mm (9.4%), 14 had anisocoria of 0.6-1.2 mm (43.8%), and 15 had anisocoria of >1.3 mm (46.9%). In darkness, the level of anisocoria increased in 19 patients, causing the first category, ≤0.5 mm, to include 1 child (3.1%), the second group to include 5 patients (15.6%), and the last group to include 26 patients (81.3%). Of the 32 Horner syndrome cases reviewed, ptosis was present in 100% of cases. Other associated signs included heterochromia (28.1%), anhidrosis (9.4%), straight hair on affected side/curly unaffected (9.4%), neck mass (6.3%). In 37.5% of cases, imaging results were negative and no specific etiology was determined
In a study of 592 children without Horner syndrome, pupillary size was found to increase with age, while the degree of anisocoria remained stable in both light and dark. About half of the pediatric population studied had anisocoria of up to 0.5 mm. In children with a diagnosis of Horner syndrome, the majority had anisocoria ≥1.3 mm, with the discrepancy in pupil size becoming more apparent in levels of low light intensity. The level of anisocoria increased in the dark in 19 of 32 Horner syndrome cases reviewed (59.3%), with an average increase of 0.57 mm. In this study, anisocoria greater than 1.3 mm was rarely found to be physiologic (3.4%).
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