DR Medhat MRCP

o Anhydrosis can determine the site of lesion in Horner`s syndrome :
Central lesion Preganglionic lesion Postganglionic lesion
Anhydrosis Face,arm&trunk Only face No anhydrosis
Causes 1. Stroke.
2. Syringomyelia.
3. Multiple sclerosis
4. Encephalitis.
5. Tumors
1. Pancoast tumor.
2. Thyroidectomy.
3. Trauma.
4. Cervical rib.
1. Carotid artery dissection.
2. Carotid aneurysm.
3. Cavernous sinus thrombosis.
4. Cluster headache.
سؤال مهم : Ptosis o
Causes of bilateral ptosis
1. Myotonic dystrophy.
2. Myasthenia gravis.
3. Syphilis.
4. Congenital.
Argyll-Robertson pupil (ARP) :
- Miotic ,irregular ,eccentric pupil
- Reactive to accommodation but
Not to light reflex
- Causes : Syphilis
Sarcoidosis
DM
M.S
Causes of unilateral ptosis
1. Third nerve palsy (dilated pupil).
2. Horner`s syndrome (constricted pupil)
Argyll-Robertson pupil (whore`s eye) i.e
( accommodate but doesn`t react)
Pin-point pupil(< 2 mm under normal light) :
• Causes :
- Pontine hemorrhage
- Opiate (morphine) toxicity.
- Organophosphorous poisoning
B. Mydriasis : causes
هام جدا pupil) 1. Occulomotor nerve palsy (dilated fixed
2. Marcus –Gunn pupil : in early optic nerve lesion
3. Holmes-Adie`s pupil : in females, post H.Zoster, unilateral (80%),dilated
,non-reactive to light,slow accommodation →diagnosis : severe miosis in
affected eye with pilocarpine drops (weak miotic response/healthy eye)
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