The Degree of Anisocoria in Pediatric Patients With Horner Syndrome When Compared to Children Without Disease

Abstract

In a study of 592 children without Horner syndrome, the average pupillary size increased with age, but the degree of anisocoria remained stable with increasing age. Over half of the children studied had anisocoria up to 0.5 mm (62.84%), but rarely had anisocoria greater than 1.3 mm (3.70%). In children with a diagnosis of Horner syndrome, the majority had anisocoria greater than 1.3 mm, with the discrepancy in pupil size becoming more apparent in low levels of light intensity. Anisocoria greater than 1.3 mm is unlikely to be physiologic in a child; therefore, he or she should be carefully evaluated for other localizing signs, such as ptosis, anhidrosis, and neck mass. [J Pediatr Ophthalmol Strabismus. 2016;53(3):186-189.].

Clinical Presentations of Pediatric Horner Syndrome

“…This is consistent with the study done by Suh et al, in which 100% of the 32 diagnosed Horner syndrome patients had associated ptosis [4]. In addition, the study by Suh also found that 9.4% of the patients had anhidrosis [4].…”

“…This finding was in accordance with the study by Suh et al [4]. In addition, given that only five of the patients had pupil size data available, physicians should be reminded to measure pupil size to determine the degree of anisocoria when it is present.…”

“…A study conducted by Suh et al found that in children with no Horner syndrome, over half of the patients studied had physiologic anisocoria up to 0.5 mm [4]. In patients with Horner syndrome, the majority had anisocoria greater than 1.3 mm [4]. This study suggested that anisocoria greater than 1.3 mm is therefore unlikely to be physiologic.…”

“…There is currently limited data available to physicians detailing the degree of anisocoria that should warrant further evaluation for Horner syndrome. A study conducted by Suh et al found that in children with no Horner syndrome, over half of the patients studied had physiologic anisocoria up to 0.5 mm [4]. In patients with Horner syndrome, the majority had anisocoria greater than 1.3 mm [4].…”

“…When a patient presents with Horner syndrome, in addition to the classic triad of eyelid ptosis, anhidrosis, and anisocoria, diagnostic signs can include heterochromia irides, straight hair on the affected side with curly hair on the unaffected side, and reverse ptosis [4]. In pediatric patients with Horner syndrome, impaired facial flushing may be more apparent than anhidrosis [5].…”