Adverse effects of apraclonidine used in the diagnosis of Horner syndrome in infants

Current pharmacologic testing for horner syndrome

“…Instillation of 10% cocaine had confi rmed an oculosympathetic paresis 3 days after onset of symptoms, and MRI/MRA radiographically confi rmed the presence of a dissection. The authors recommended caution in cases of acute or infantile Horner syndrome and suggested that cocaine remain the preferred method of testing [39].…”

Pharmacologic testing in Horner's syndrome – a new paradigm

“…Apraclonidine 1% has been successfully used to diagnose OSP in paediatric patients, 10 even though 5 infants experienced systemic side-effects after topical use of 0.5% and 1.0% apraclonidine. 16 The side-effects included lethargy, difficulty to rouse, bradycardia and shallow respiration with decreased oxygen saturation of 8 -10 hours, which are similar to those with topical brimonidine. Four of the infants were younger than 6 months.…”

Isolated Horner syndrome and syringomyelia in a child

“…9 Although 0.5% apraclonidine is readily available in the clinic, it has been reported to cause extreme drowsiness and even unresponsiveness in patients who are younger than 6 months of age and therefore should be used with caution in that population. 10 In older infants and children, however, the side effect profile of apraclonidine 0.5% is milder than that of cocaine 4% and may therefore be the diagnostic tool of choice in that population. 9 In children, isolated Horner syndrome has been reported with a variety of compressive etiologies, including neuroblastoma, Ewing sarcoma, xanthogranuloma, syringomyelia, and petrous internal carotid artery aneurysm.…”