Images in Neurology |

Right Eye Droop

Aashish Anand, MD; Smita I. Negi, MD
Arch Neurol. 2012;69(11):1516. doi:10.1001/archneurol.2012.217.
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A 64-year-old woman with no visual or systemic symptoms consulted for a cosmetic procedure on her right eyelid that had been progressively drooping for 3 months (Figure 1). Ocular examination was significant for dilatation lag in the right pupil and an anisocoria, with the right and left pupils measuring 1.5 mm and 3.5 mm, respectively. The right pupil failed to dilate with 4% cocaine drops but dilated with 1% hydroxyamphetamine drops. Mild right facial flushing but no impaired sweating was detected clinically. Systemic examination was significant for a right-sided neck fullness that moved upward with swallowing.

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Figure 1. Right eye ptosis and miosis in a 64-year-old woman with Horner syndrome.

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Figure 2. Images of the patient's neck and chest. A, Chest x-ray shows deviation of the trachea to the left (arrow). B, Neck ultrasonography shows an oval, well-defined lesion with anechoic homogenous inner structure consistent with a simple thyroid cyst in the right lobe of the thyroid (arrow). C, A computed tomographic scan (coronal section) shows a cystic thyroid lesion (white arrow) stretching the right carotid sheath laterally (black arrow).




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