A 67-year old lady presented to the accident and emergency department with horizontal double-vision on looking to the left. When examined she was found to have a left sixth nerve palsy and mild ptosis of the left eye. When she was examined by the neurologist they confirmed the 6th nerve palsy and felt she also had features of a Horner's syndrome.
What are the clinical features of a Horner's syndrome?
Where is the lesion?
What is the most likely diagnosis?
Describe the sympathetic innervation of the orbit and eye?
Is the Horner's syndrome pre or post ganglionic and what pharmacological tests can be done to localise the lesion?
Recommended revision: How to examine eye movements (including the use of the alternate cover test) and the pupils and the neuroanatomy of the cavernous sinus, superior orbital fissure and sympathetic and parasympathetic innervation of the orbit.