Apraclonidine Is Better Than Cocaine for Detection of Horner Syndrome

Frontiers in Neurology
Fion Bremner

Abstract

Background: In suspected cases of Horner syndrome pharmacological confirmation is often required before embarking on further investigations. There are two drugs currently used for this purpose that are commercially available for topical administration: cocaine (2-10%) and apraclonidine (0.5-1.0%). Aims: To evaluate and compare the effects of both drugs in normal eyes and eyes with Horner syndrome Methods: This is a retrospective study looking at the outcome of 660 consecutive pharmacological tests with these two drugs in one tertiary referral center over 14 years. Eyes were categorized as "normal" or "Horner syndrome" based on non-pharmacological criteria (pupillometric and clinical evidence). Pupil diameters in the dark and in bright light were measured by pupillometry before and 40 min after administration of the test drug (either 4% cocaine or 0.5% apraclonidine). Results: Cocaine dilated the normal pupil (measured in bright light: mean +2.1 mm, range -0.4 to +3.9 mm; 95% lower limit +0.5 mm); the extent of this response was not significantly affected by patient age or pupil size, but was 50% less in brown eyes compared with blue or green eyes, and 20% less if the measurements were made in the dark. In eyes with Horner syndr...Continue Reading

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Citations

Oct 8, 2020·Pediatric Radiology·Hedieh Khalatbari, Gisele E Ishak
Jan 14, 2021·Annals of Neurology·Shiwen KoayValeria Iodice
Apr 15, 2021·Klinische Monatsblätter für Augenheilkunde·Lucìa Moreno-CastroJuan José Pérez-Santonja
May 2, 2020·Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society·Sasha A MansukhaniM Tariq Bhatti
May 21, 2021·Frontiers in Neurology·Abdus Samad AnsariKatie M Williams
Nov 6, 2021·Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus·Amgad A EldibMatthew S Pihlblad

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