Question #363

You notice that a patient has a constricted pupil on the right. What other clinical signs should you look for?

Flushed left check

Gaze fixed downwards and outwards

Weakness in right shoulder abduction

Drooping eyelid

Hyperhidrosis on the right check

The patient may have Horner’s syndrome: ptosis, miosis and anhydrosis.

Horner's syndrome can occur following damage anywhere along the length of the sympathetic chain supplying the eye. Since the sympathetic fibres leave the spinal cord at T1 damage at this level might also damage the T1 nerve root resulting in weakness of the intrinsic muscles on the hand.

An apical tumour of the lung, known as Pancoast's tumour, can also compress on the sympathetic chain at this level and may therefore present with a cough, weight loss, a Horner's syndrome and T1 radiculopathy.

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