Homer syndrome is characterized by all EXCEPT

D. i.e. (Exophthalmos) (356 - Khurana 4th)HORNERS SYNDROME - (Oculosympathetic palsy)Clinical features* Mild ptosis (usually 1- 2 mm) as a result of weakness of mullermuscles* Slight elevation of the inferior eyelid as a result of weakness of inferior tarsal muscle narrowed palpebral fissure* Miosis - resulting from unopposed action of the sphincter pupillae with resultant anisocoria which is accentuated in dim light. Since the Homer pupil will not dilate like its fellow* Normal reactions to light and near* Reduced ipsilateral sweating {Anhidrosis) but only if the lesion is below the superior cervical ganglion because the fibres supplying the skin of the face run along the external carotid artery* Slight enophthalmos (due to loss of tone of muller muscle)* Hypochromic - heterochromia (irides of different colour- Homer is lighter) may be seen if the lesion is congenital or long standing* The pupil is slow to dilate* Less important sign include - hyperactive accommodation, ocular hypotony and conjunctival hyperaemia* Hirschberg's test is used for squint*** Jones test is used to detect - Nasolacrimal duct block*** Swinging flash light test is used to examine pupil**Causes of Horner's Syndrome 806 -Kansi 6th1. Central(first order neuron)2. Pre- ganglionic(second order neuron)4. Post ganglionic(third order neuron)* Brainstem disease (tumour, vascular demyelination)* Syringomyelia* Lateral medullary (Wallenberg) syndrome* Spinal cord tumour* Diabetic autonomic neuropathy* Pancoast tumour* Carotid and aortic aneurysm and dissection* Neck lesions (glands trauma. Post surgical)* Cluster headache* ICA dissection* Nasopharyngeal tumour* Otitis media* Cavernous sinus mass