Clinical Presentations of Pediatric Horner Syndrome at Children's Hospital and Medical Center in Omaha

Abstract

Purpose : Anisocoria with a concern of Horner syndrome is a common reason for referrals to optometrists and ophthalmologists. A retrospective analysis was performed in order to understand the multiple signs of Horner syndrome and to recommend protocols for pediatricians to obtain an accurate diagnosis of Horner syndrome and basis for appropriate referral.

Methods : The medical records of 17 pediatric patients with Horner syndrome, neonates to eighteen years of age, were collected and analyzed from January 1^st, 2010 – February 1^st, 2015. Data recorded by the neurology department included age, presenting symptoms, other medical history, allergies, medications, pupil size, presence of anhidrosis, and presence of ptosis. Also, from those patients who had pupil sizes measured, the average degree of anisocoria was calculated.

Results : In addition to anisocoria, all 17 Horner syndrome patients had other clinical findings of Horner’s:100% had ptosis, and 25% had anhidrosis. Of the available pupil size data, the mean level of anisocoria was 2.06 mm with a range of 1-4 mm and standard deviation of 1.17 mm. Other findings often associated with pediatric Horner syndrome such as heterochromia and inverse ptosis were not recorded by the pediatricians or neurology department.

Conclusions : In all of the patients, a diagnosis of Horner syndrome was confirmed with the presence of anisocoria along with ptosis and other clinical findings. Next to ptosis, anhidrosis was the most common clinical presentation. In addition to the actual presence of anisocoria, we recommend that pediatricians and neurologists measure the actual pupil sizes to determine the degree of anisocoria in dark and in light, as it may help distinguish normal physiologic conditions from underlying pathology. Also, documenting other clinical findings of anhidrosis, ptosis, or reverse ptosis may be helpful in making an accurate diagnosis of Horner syndrome.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.