Ocular Effects of the Sympathetic Nervous System

Case 3

A patient entered the examination room with a complaint of blurry vision at distance, OU. The doctor performed VAs, manifest refraction, and an ocular health examination, which were unremarkable except for myopia OU.

The chair skill evaluation yielded the following results:

Pupils: unequal (dim light: OD 2.5mm, OS 5mm; bright light: OD 2mm, OS 2.5mm), round, reactive to light and accommodation OU
Eyelid position:
- Right upper lid (RUL) 1mm lower than left upper lid (LUL)
- Right lower lid (RLL) 0.5mm higher than left lower lid (LLL)
Interpalpebral distance (IPD):
- Right IPD: 7mm
- Left IPD: 8.5mm

The patient was diagnosed with Horner’s syndrome, OD, and referred to neurology.

Question 4

How did pupillary testing help the clinician in Case 3 arrive at the appropriate diagnosis?

Click the appropriate answer.

It didn't; no useful information was gleaned from pupil testing

The presence of anisocoria was suspicious for Horner’s syndrome, but did not indicate which eye was affected

The presence of anisocoria was suspicious for Horner’s syndrome, and indicated which eye was affected

Question 5

How did eyelid position testing help the clinician in Case 3 arrive at the appropriate diagnosis?

Click the appropriate answer?

It didn't; no useful information was gleaned from eyelid position testing

The presence of relative upper lid droop and lower lid elevation were suspicious for Horner’s syndrome, but did not indicate which eye was affected

The presence of relative upper lid droop and lower lid elevation were suspicious for Horner’s syndrome, and indicated which eye was affected

Question 6

How did IPD testing help the clinician in Case 3 arrive at the appropriate diagnosis?

Click the appropriate answer?

It didn't; the findings were now-specific

It is diagnostic for Horner's syndrome in the eye with the narrower fissure

It is diagnostic for Horner's syndrome in the eye with the wider fissure

Page 10 of 25 | E-mail | Back to Top