HORNER SYNDROME DUE TO TRAUMATIC CLAVICLE FRACTURE

• Main Author: Guerra, Marta
• Publication Date: 2017
• Other Authors: Marques, Sara, Almeida, Catarina, Tavares, Rui, Estrada, Joaquim
• Format: Report
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://doi.org/10.48560/rspo.10643
• topic: Comunicações Curtas e Imagens em Oftalmologia

Objective: Describe a unique case of preganglionic Horner Syndrome due to middle third clavicle fracture. Methods: A 40 year-old man, hemodynamically stable, presented at the emergency room with left ptosis and miosis after a car accident. Complete ophthalmological examination including external exam, pupil and extraocular movement evaluation, best corrected visual acuity, biomicroscopy, tonometry and fundus exam was performed. Further investigation included chest and pelvic X-rays and pharmacological testing of pupillary reactions. Results: Ophthalmological examination showed no alterations except for ptosis and miosis on the left eye. The X-rays revealed displaced clavicle fracture, third rib and ischiopubic branch fractures on the left side. Apraclonidine and phenylephrine tests diagnosed second-order sympathetic chain lesion. One year later, ptosis persisted and conjunctivo-müllerectomy was performed. Conclusion: Traumatic mild ptosis and miosis alert to sympathetic chain interruption. Pharmacological tests are essential to localize and identify its cause. We present a preganglionic Horner Syndrome due to isolated middle third clavicle fracture, which to our knowledge is reported for the first time.