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Case Reports
. 2020 Apr-Jun;10(2):42-44.
doi: 10.4103/jwas.jwas_18_21. Epub 2022 Mar 26.

An 8-month-old Baby Girl with Slight Drooping of Left Upper Eyelid

Niranjan K Pehere  1 , Gordon Neale Dutton  2
Affiliations
Case Reports

An 8-month-old Baby Girl with Slight Drooping of Left Upper Eyelid

Niranjan K Pehere et al. J West Afr Coll Surg. 2020 Apr-Jun.

Abstract
in English, French

An 8-month-old baby girl, who accompanied her sister with an eye problem, was incidentally noticed to have smaller left eye compared to the right. The mother said that it had been present for 2 months. The child showed no detectable focal neurological deficits. Her vision was age appropriate in both eyes. A slight left-sided ptosis was present. Her eye movements were full in both eyes and there was no evidence of strabismus. Bilateral fundus examination was normal. The child had anisocoria (left pupil being smaller than the right one) and left hemifacial anhidrosis, which prompted the diagnosis of Horner's syndrome. Magnetic resonance imaging of her chest showed a mass lesion in the apical region of the left lung which was later excised and found to be a neuroblastoma. This emphasizes the importance of having an eye on the siblings of children who come to the hospital.

Une petite fille de 8 mois, qui accompagnait sa soeur souffrant d’un problème oculaire, a par hasard été remarquée pour avoir un oeil gauche plus petit que le droit. La mère a dit qu’il était présent depuis 2 mois. L’enfant n’a montré aucun déficit neurologique focal détectable. Sa vision était adaptée à l’âge pour les deux yeux. Un léger ptosis gauche était présent. Ses mouvements oculaires étaient normaux pour les deux yeux et il n’y avait aucun signe de strabisme. L’examen bilatéral du fond d’oeil était normal. L’enfant avait une anisocorie (la pupille gauche étant plus petite que la droite) et une anhidrose hémifaciale gauche, ce qui a conduit au diagnostic de syndrome de Horner. Une IRM thoracique réalisée a montré une masse tissulaire de la région apicale du poumon gauche qui a ensuite été réséquée.L’examen anatomopathologique a révélé qu’ils agissait d’un neuroblastome. Cela souligne l’importance de garder un oeil sur la fratrie des enfants qui viennent consulter à l’hôpital.

Keywords: Acquired Horner’s syndrome in infants; Pupil; neuroblastoma.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Clinical picture of the child showing mild ptosis in left eye
Figure 2
Figure 2
Mild anisocoria in light (diameter of right pupil about 2.5 mm and left pupil 2 mm)
Figure 3
Figure 3
Anisocoria increasing in the dark since left pupil fails to dilate (diameter of right pupil about 4 mm and left pupil 2 mm)
Figure 4
Figure 4
MRI chest showing a mass lesion in apical region of left lung
See this image and copyright information in PMC

References

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    1. Martin TJ. Horner syndrome: A clinical review. ACS Chem Neurosci. 2018;9:177–86. - PubMed
    1. Higaki M1, Kurai D, Ito A, Saraya T. Evidence for hypohydrosis as clinical clue to diagnosis of Horner’s syndrome. BMJ Case Rep 2013. 2013 bcr2013009732. - PMC - PubMed
    1. Lambert JE, Christiansen SP, Peeler CE. Don’t miss this! Red flags in the pediatric eye exam: Pupils. J Binocul Vis Ocul Motil. 2019;69:102–5. - PubMed
    1. Graef S, Irwin MS, Wan MJ. Incidence and prognostic role of the ocular manifestations of neuroblastoma in children. Am J Ophthalmol. 2020;213:145–52. - PubMed

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