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Horner’s syndrome and apraclonidine eye drops
  1. Edward Margolin1,2,
  2. Trishal Jeeva-Patel1,
  3. Nicolin Hainc3
  1. 1Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
  3. 3Medical Imaging, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Edward Margolin, Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5S, Canada; edmargolin{at}

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A 62-year-old woman had noticed a droopy right eyelid for 2 weeks. She had a history of stage 2 breast cancer, treated 10 years before with mastectomy, radiotherapy and chemotherapy. She was otherwise healthy and took no medications. On examination, there was mild right upper eyelid ptosis and anisocoria, more pronounced in the dark, with the right pupil smaller than the left. Testing with 0.5% apraclonidine drops reversed the anisocoria (figure 1), and we diagnosed a right Horner’s syndrome.

Figure 1

(A) Right pupil is smaller than the left with mild right upper lid ptosis. (B) Forty-five minutes after instillation of 0.5% apraclonidine, there is resolution of ptosis and reversal of anisocoria, with the left pupil now larger than the right.

On further questioning, she reported a recent onset of pain along the right lower ribs. Given the previous history of breast cancer, we obtained a dedicated MR scan of the cervical and …

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  • Contributors All authors contributed equally to the writing/revision of the manuscript and obtaining the data for the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed by Luke Bennetto, Bristol, UK.

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