Horner's Syndrome?

[tweety09]

I went to my OD today due to uneven pupils. They are not constantly uneven, but it is always the same pupil that is smaller when it happens. OD diagnosed me with Horner's Syndrome, but she said that I only have a mild case because I have no other symptoms other than the pupil. (i don't have issues with lack of flushing/sweating on that side and my eyelid is not drooping). She asked me if I had injured my neck or had neck surgery, which I had not. I have no other health issues other than high blood pressure, which I take lisinopril for. She recommended an MRI to rule out small tumor or mini-stroke. My eye pressure was normal in both eyes, and my optic nerve is not swollen. She did rule out tonic pupil because of the way my pupils react to light. Is it possible to have Horner's syndrome without a droopy eyelid? It seems that everything I read implies that you have to have the droopy eyelid as a symptom. I guess I am confused!
Thanks!

[John C Hagan III, MD, FACS, FAAO]

Let us know what you find out if you have time.

JCH MD

[tweety09]

Thank you so much for the info!! I will get a referral from my primary care to see a neuro-ophthalmologist.  

[John C Hagan III, MD, FACS, FAAO]

You should not rush into a $10,000 work up on the word of an optometrist that is not a physician, not a MD, not been to medical school and has less than half the experience or training of a MD. She is way over her head making those kinds of recommendations for work up (she should have referred you to an ophthalmologist straight off).

Horner's syndrome requires a dropy lid to make the DX.

Go to www.aao.org and see if there is a neuroophthalmologist near you even if you have to drive an hour or two. When you go take 4-5 good facial photographs that show your pupils and lids good from 5 and 10 and 15 years ago.  Your family MD can help make the appointment.

Do not allow the technicians to put any drops in your eye till the Eye MD sees you (not likely to happen in a neuro-ophthal office but just make sure).

I think there is a good chance you don't have Horner's and you may be spared an extensive and expensive work-up.  Up to 10% of the population have unequal pupils (aneisocoria) without any eye or body disease.

JCH MD