Clinical presentationA 67-year-old recurrent uterine cervical cancer patient with left supraclavicular lymph node metastasis presented with one week history of left eyelid drooping. On history taking and examination there was a 3mm ptosis of the left upper eyelid, a smaller left pupil, and left facial hypohidrosis (Figure 1A). Administration of one drop of 0.5% apraclonidine in both eyes resulted in reversal of anisocoria and resolution of ptosis (Figure 1B).Answer and discussionOculosympathetic paresis, also known as Horners syndrome, is a characteristic triad of features which consists mainly of miosis, partial upper eyelid ptosis and facial anhidrosis on the ipsilateral side. It occurs as a result of disease affecting the ipsilateral sympathetic pathway along its course from the hypothalamus to the orbit, and it may also be congenital or iatrogenic.1,2 It should prompt clinicians to investigate vigorously any lesion of the oculosympathetic tract as it may be the manifestation of an important underlying condition such as malignant tumor. Neoplasia is the most common cause and accounts for 35-60% of all cases.3 Figure 1A: Ptosis of the left upper eyelid and a smaller left pupil. Figure 1B: Reversal of anisocoria and resolution of ptosis after administration of one drop of 0.5% apraclonidine in both eyes.

Clinical presentationA 67-year-old recurrent uterine cervical cancer patient with left supraclavicular lymph node metastasis presented with one week history of left eyelid drooping. On history taking and examination there was a 3mm ptosis of the left upper eyelid, a smaller left pupil, and left facial hypohidrosis (Figure 1A). Administration of one drop of 0.5% apraclonidine in both eyes resulted in reversal of anisocoria and resolution of ptosis (Figure 1B).Answer and discussionOculosympathetic paresis, also known as Horners syndrome, is a characteristic triad of features which consists mainly of miosis, partial upper eyelid ptosis and facial anhidrosis on the ipsilateral side. It occurs as a result of disease affecting the ipsilateral sympathetic pathway along its course from the hypothalamus to the orbit, and it may also be congenital or iatrogenic.1,2 It should prompt clinicians to investigate vigorously any lesion of the oculosympathetic tract as it may be the manifestation of an important underlying condition such as malignant tumor. Neoplasia is the most common cause and accounts for 35-60% of all cases.3 Figure 1A: Ptosis of the left upper eyelid and a smaller left pupil. Figure 1B: Reversal of anisocoria and resolution of ptosis after administration of one drop of 0.5% apraclonidine in both eyes.