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. 2005 Nov;89(11):1442-4.
doi: 10.1136/bjo.2005.074492.

The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis

F Koc  1 , S Kavuncu, T Kansu, G Acaroglu, E Firat
Affiliations

The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis

F Koc et al. Br J Ophthalmol. 2005 Nov.

Abstract

Aims: To evaluate the sensitivity and specificity of 0.5% apraclonidine test in the diagnosis of oculosympathetic paresis (OSP).

Method: Apraclonidine (0.5%) was administered to 31 eyes, nine with a diagnosis of Horner syndrome (HS), 22 with bilateral OSP caused by diabetes, and to 54 control eyes. All were confirmed with the cocaine test. The effects on pupil diameter and upper eyelid level were observed 1 hour later.

Results: Apraclonidine caused a mean dilation of 2.04 mm (range 1--4.5) (p<0.001) in the pupils with OSP and it caused pupillary constriction in the control eyes with a mean change of -0.14 mm (range 0.5 to --1) (p<0.05). It caused reversal of anisocoria in all HS cases. Its effects on both pupil diameters and upper lid levels differed significantly between the groups (p<0.001). The mean elevation in the upper lid was 1.75 mm (range 1--4) in the OSP group (p<0.001) and 0.61 mm (range 0--3) in the control group (p<0.001).

Conclusion: The effect of the apraclonidine (0.5%) test on the pupil diameter was diagnostic for OSP and had at least the same sensitivity and specificity as the cocaine test for the diagnosis of OSP.

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Figures

Figure 1
Figure 1
Horner syndrome in left eye. (A) Baseline condition, miosis and ptosis in left eye. (B) No change in the left eye 1 hour following 10% cocaine instillation. (C) Anisocoria reversal and lid elevation in the left eye 1 hour after instillation of 0.5% apraclonidine.
Figure 2
Figure 2
Bilateral OSP caused by diabetes mellitus. (A) Baseline condition, bilateral miosis and ptosis. (B) No change 1 hour later 10% cocaine instillation. (C) Bilateral dilation and lid elevation 1 hour after instillation of 0.5% apraclonidine.
Figure 3
Figure 3
Pseudo-Horner syndrome. (A) Baseline anisocoria. (B) Symmetrical dilation of both pupils 1 hour after 10% cocaine instillation. (C) Symmetrical bilateral miosis 1 hour after instillation of 0.5% apraclonidine.
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