Horner Syndrome

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Right Horner syndrome.

Note the anisocoria (right pupil smaller than left pupil) and right upper and lower ptosis. In a child, the most common cause of congenital Horner syndrome is birth trauma to the brachial plexus, with acquired childhood Horner syndrome concerning for neuroblastoma. Apraclonidine should be avoided in small children due to the risk of CNS and respiratory depression.

Image credit: American Academy of Ophthalmology. Used with permission for educational purposes.