<prompt> All of the following clinical findings are seen in Horners syndrome, Except:MiosisAnhidrosisHeterochromia of irisApparent Exophthalmos  <response>: Answer is D Apparent Exophthalmos: Homers Syndrome is associated with Apparent Enophthalmos and not Apparent Exophthalmos Apparent Enophthalmos may be seen in Horners syndrome Horners syndrome may be associated with apparent enophthalmos as a result of a narrow palpebral fissure, an appearance that the affected eye is located deeper sunken in compared with the unaffected eve. Heterochromia of iris may be seen in Horners syndrome Heterochromia refers to a difference in the colour of iris between the two eyes. Homers syndrome may be associated with sympathetic heterochromia. Sympathetic heterochromia is characterized by pallorprogressive fading of the iris on the affected side Hypochromic Heterochromia and usually accompanies occulosympathetic paralysis that is sustained early in life before age 2 Congenital Horners Syndrome. Progressive Heterochromia from acquired Homers syndrome in adults is rare. Anhidrosis and Miosis are classical features of Horners Syndrome Anhidrosis ipsilateral facial anhidrosis is one of the classical features of Homers Syndrome seen in lesions of sympathetic pathway below the bifurcation of the carotid aery. Miosis and Ptosis are the other typical features of Horners Syndrome Clinical. Finding In Horners Syndrome Classical Triad Miosis Ptosis Anhidrosis Note: Anhidrosis is absent in lesions at the level of internal carotid aery or above sudomotor and vasomotor fibers to the face follow the external carotid aery at the bifurcation. Other Signs of Horners Syndrome Apparent Enophthalmos dt narrow palpebral fissure Anisocoria Heterochromia of iris Dilation lag slow dilation of pupil after lights are dimmed Increased accommodative amplitude or accommodative paresis Transient ocular Hypotonia and conjunctival Hyperemia Horners Syndrome from lesion of sympathetic Pathway Horners syndrome from lesion of sympathetic pathway below bifurcation of carotic aery above bifurcation of carotid aery Ptosis Miosis Anhidrosis Ptosis Miosis Anhidrosis is absent Clinical Findings in Homers Syndrome Taken from Localization in Clinical Neurology Lippincott Williams 2011208: Ipsilateral mild usually 2 mm ptosis due to denervation of the Mullers muscle of the upper eyelid Reverse Ptosis or Upside down ptosis due to sympathetic denervation to the lower eyelid retractors Apparent enophthalmos Miosis Anisocoria due to ipsilateral miosis Dilation lag slow dilation of the pupil after lights are dimmed Increased accommodative amplitude or accommodative paresis Patients hold the near card closer to read Transient acute phase ocular hypotony and conjunctival hyperemia Heterochromia of the iris Variable ipsilateral facial anhidrosis Ipsilateral straight hair in some congenital cases usually congenital but rarely acquired Rarely neurotrophic corneal endothelial failure with pain and stromal edema rare. Ipsilateral nasal obstruction with contralateral rhinorrhea with infantile cases rare. 