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Ophthalmology for the Oncologist





Causes include:

3rd Nerve paresis


  • ptosis >2mm
  • exotropia (divergent) and Hypotropia (down)
  • limitation of elevation / depression / adduction
  • pupil dilated and poorly reactive
  • can be pupil sparing

Horner syndrome


  • 1-2mm ptosis
  • pupillary miosis (smaller) but reactive
  • lower lid inverse ptosis (leading to apparent enophthalmos)
  • may have ipsilateral facial flushing / impaired sweating (anhydrosis)

commonest identifiable cause of an isolated Horners is a Neuroblastoma

Tumour involvement of the upper lid

  • commonest tumour involving the eyelid is a capillary haemangioma
  • can cause occlusion of the visual axis or astigmatism from compression

Lambert-Eaton syndrome

  • rare myasthenia type syndrome
  • para-neoplastic


The picture below shows a right Horners syndrome (pupillary miosis, right upper lid small ptosis and lower lid inverse ptosis).



Clinical Tip :


Varying the ambient light can help identify the abnormal pupil.

  • If pupil discrepancy is greater in the dark – the abnormal pupil is the small one
  • If pupil discrepancy is greater in the light – the abnormal pupil is the large one





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