Comparing efficacies of 0.5% apraclonidine with 4% cocaine in the diagnosis of horner syndrome in pediatric patients.
OBJECTIVE
The aim of this study was to compare the efficacy of 0.5% apraclonidine with that of 4% cocaine and to evaluate its safety in the diagnosis of Horner syndrome in pediatric patients.


METHODS
This was a randomized, crossover study, wherein 10 patients with a probable diagnosis of Horner syndrome were assigned to undergo pharmacological testing with 4% cocaine and 0.5% apaconidine. The difference in the pupil diameters of each eye was recorded under dim light before and 1 h after 0.5% apraclonidine or 4% cocaine was instilled. Any adverse effects were noted during examination or reported by the patients' parents were recorded.


RESULTS
The mean differences in pupil diameter before and after 4% cocaine testing were -2.08 and -2.97 mm, respectively (P = 0.0047). All patients had an anisocoria greater than 1 mm after 4% cocaine testing. The mean difference in pupil diameter before and after 0.5% apraclonidine was instilled were -2.04 and +1.08 mm, respectively (P = 0.005). All patients showed a reversal of anisocoria after 0.5% apraclonidine testing. Conjunctival hyperemia was noted in 2 patients, but systemic adverse effects were not noted during examination nor reported by the patients' parents.


CONCLUSIONS
The application of 0.5% apraclonidine in pediatric patients is safe and effective in the diagnosis of Horner syndrome.
Chen
Po-Liang
PL
Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Republic of China.
Chen
Jiann-Torng
JT
Lu
Da-Wen
DW
Chen
Yo-Chang
YC
Hsiao
Chih-Hsien
CH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D003042:Cocaine / Q000009:adverse effects; D018592:Cross-Over Studies; D005260:Female; D006732:Horner Syndrome / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D011680:Pupil / Q000187:drug effects
C016986:apraclonidine; D003042:Cocaine; D003000:Clonidine