A 62-year-old woman had noticed a droopy right eyelid for 2 weeks. She had a history of stage 2 breast cancer, treated 10 years before with mastectomy, radiotherapy and chemotherapy. She was otherwise healthy and took no medications. On examination, there was mild right upper eyelid ptosis and anisocoria, more pronounced in the dark, with the right pupil smaller than the left. Testing with 0.5% apraclonidine drops reversed the anisocoria (figure 1), and we diagnosed a right Horner’s syndrome. Figure 1 (A) Right pupil is smaller than the left with mild right upper lid ptosis. (B) Forty-five minutes after instillation of 0.5% apraclonidine, there is resolution of ptosis and reversal of anisocoria, with the left pupil now larger than the right. On further questioning, she reported a recent onset of pain along the right lower ribs. Given the previous history of breast cancer, we obtained a dedicated MR scan of the cervical and …

中文翻译：

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霍纳综合征和阿可乐定滴眼液

一名 62 岁女性注意到右眼睑下垂 2 周。她有 2 期乳腺癌病史，10 年前接受过乳房切除术、放疗和化疗。她其他方面都很健康，没有服用任何药物。检查时，右上眼睑有轻度上睑下垂和瞳孔不等，在黑暗中更明显，右瞳孔比左瞳孔小。使用 0.5% 的阿普乐定滴剂进行测试逆转了等距不齐（图 1），我们诊断出右霍纳综合征。图 1 (A) 右瞳孔比左瞳孔小，右上睑轻度上睑下垂。(B) 滴注 0.5% 的阿普可乐定 45 分钟后，上睑下垂和瞳孔不等的逆转，现在左瞳孔比右瞳孔大。在进一步询问时，她报告说最近发生了右下肋骨疼痛。