An 8-year-old male is admitted to the hospital with a drooping right eyelid (ptosis). The initial diagnosis is Horner's syndrome. Which of the following additional signs on the right side would confirm the diagnosis?
(a) Source: GAS 45, 882, 895, 980-981; GA 190, 496Horner's syndrome involves interruption of sympathetic supply to the face. This results in ptosis (drooping eyelid), miosis (constricted pupil), and anhydrosis (lack of sweating) of the face. The eye is lubricated by the lacrimal gland, which secretes in response to parasympathetic stimulation, and would be unaffected. Exophthalmos (protrusion of the globe) is frequently caused by hyperthyroidism and is not present in Horner's syndrome. Loss of sympathetic innervation leads to unopposed vasodilatation of the vessels to the face, leading to flushing rather than paleness.
Constricted pupil
Dry eye
Exophthalmos
Pale, blanched face
Head & Neck