title: False negative apraclonidine test in two patients with Horner syndrome.
abstract: BACKGROUND
  Because of denervation supersensitivity, a miotic pupil in a sympathetically-denervated eye dilates in response to a dilute or weak alpha-1-agonist drug. A reversal of anisocoria after topical apraclonidine is considered as a positive test result that diagnoses a unilateral Horner syndrome.
  
  
  METHODS
  Two women aged 34 and 46 years with a cocaine-confirmed oculosympathetic defect (Horner syndrome) were tested with 1 % topical apraclonidine on separate days.
  
  
  RESULTS
  In one patient, her miotic Horner pupil dilated marginally but not enough to reverse the baseline anisocoria. Additionally, the upper lid on the same side retracted. There was no discernable effect of apraclonidine on the normal, contralateral eye. In the second patient, there was no pupillary response to apraclonidine but there was resolution of her ptosis.
  
  
  CONCLUSIONS
  Neither patient demonstrated a reversal of anisocoria, the current criterion for diagnosing a Horner syndrome using apraclonidine. Thus, these two patients with an established oculosympathetic defect were said to have a "negative test" for Horner syndrome. Yet both women showed subtle pupil and/or lid changes in response to apraclonidine that were consistent with sympathetic denervation supersensitivity. Reversal of anisocoria following topical apraclonidine does not occur in all patients with a unilateral oculosympathetic defect and more specific parameters for defining a positive test result might optimize apraclonidine's utility as a diagnostic test for Horner syndrome.
authors.affiliation: Department of Neuro-Ophthalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland. aki.kawasaki@ophtal.vd.ch
authors.forename: A
authors.initials: A
authors.lastname: Kawasaki
authors.forename: F-X
authors.initials: FX
authors.lastname: Borruat
mesh_terms: D000316:Adrenergic alpha-Agonists; D000328:Adult; D003000:Clonidine / Q000031:analogs & derivatives*; D005188:False Negative Reactions; D005260:Female; D006732:Horner Syndrome / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D011680:Pupil / Q000187:drug effects
chemical_list: D000316:Adrenergic alpha-Agonists; C016986:apraclonidine; D003000:Clonidine