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The correlation of phenylephrine 1% with hydroxyamphetamine 1% in Horner’s syndrome
  1. H V Danesh-Meyer1,2,
  2. P Savino2,
  3. R Sergott2
  1. 1Department of Ophthalmology, University of Auckland, Auckland, New Zealand
  2. 2Neuro-ophthalmic Services, Wills Eye Hospital, Thomas Jefferson Medical School, Philadelphia, PA, USA
  1. Correspondence to: Associate professor Helen V Danesh-Meyer Department of Ophthalmology, University of Auckland, Private Bag 92019, Auckland, New Zealand; h.daneshmeyerauckland.ac.mz

https://doi.org/10.1136/bjo.2003.029371

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    Pharmacological testing in Horner’s syndrome involves the use of cocaine to confirm the diagnosis and hydroxyamphetamine to localise the lesion to the post-ganglionic (third order) or non-postganglionic neuron. However, hydroxyamphetamine bromide 1% (Paredrine) is not always readily available to the ophthalmologist. An alternative drug for localising the site of the lesion is phenylephrine 1% which can easily be prepared by dilution of stronger concentrations (2.5% or 10%) and which is almost universally available in most ophthalmologists’ offices. Because of the principle of denervation supersensitivity, a Horner’s syndrome produced by a lesion interrupting the postganglionic fibres should dilate the pupil when phenylephrine 1% is placed in the conjunctival sac. The pupil of a patient with central (first order) Horner’s syndrome should not dilate, while a pre-ganglionic (second order) pupil may dilate minimally1; a normal pupil may, at best, dilate minimally. The purpose of this study was to compare the pupillary response of patients with Horner’s syndrome to phenylephrine 1% and hydroxyamphetamine 1%.

    Fourteen consecutive patients with Horner’s syndrome were prospectively tested with cocaine …

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