Horner's syndrome differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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It is important to distinguish the ptosis caused by Horner’s syndrome from the ptosis caused by a lesion to the oculomotor nerve. In the former, the ptosis occurs with a constricted pupil (due to a loss of sympathetics to the eye), whereas in the latter, the ptosis occurs with a dilated pupil (due to a loss of innervation to the sphincter pupillae). In an actual clinical setting, however, these two different ptoses are fairly easy to distinguish. In addition to the blown pupil in a CN III (oculomotor nerve) lesion, this ptosis is much more severe, occasionally occluding the whole eye. The ptosis of Horner’s syndrome can be quite mild or barely noticeable.

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