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Fig. 2 —Pharmacologic diagnosis and localization of Horner syndrome.
Instillation of one drop of 10% cocaine solution is used for pharmacologic
diagnosis. Cocaine inhibits reuptake of norepinephrine at synaptic junction of
postganglionic fibers and iris dilator muscle and results in pupillary
dilation, but in Horner syndrome pupil does not dilate. One percent
hydroxyamphetamine solution releases norepinephrine from sympathetic synaptic
terminal, which dilates pupil in Horner syndrome only if postganglionic neuron
is intact. So 1% hydroxyamphetamine solution can be used for differential
diagnosis of central and preganglionic from postganglionic lesions.
