In children, Horner's syndrome sometimes leads to heterochromia, a difference in eye color between the two eyes. The pupil's light reflex is maintained as this is controlled via the parasympathetic nervous system. Sometimes there is flushing on the affected side of the face due to dilation of blood vessels under the skin. The phenomenon of enophthalmos is seen in Horner's syndrome in cats, rats, and dogs. The ptosis from inactivation of the superior tarsal muscle causes the eye to appear sunken in, but when actually measured, enophthalmos is not present. Patients may have apparent enophthalmos (affected eye looks to be slightly sunken in) but this is not always the case. It inactivates the superior tarsal muscle which produces ptosis. It inactivates the dilator muscle and thereby produces miosis. Interruption of sympathetic pathways leads to several implications.
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