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Poster #59 ACQUIRED HORNER'S SYNDROME: A SERIES OF CASE PRESENTATIONS. Shilla Patel, OD, Pauline Ilsen, FAAO, West Los Angeles VA Healthcare Center. BACKGROUND: Horner's syndrome results from disruption of the sympathetic innervation to the eye anywhere along its three neuron curcuit beginning from the hypothalamus. A familiarity with the oculosympathetic pathway, the structures which are in close proximity to it, and the disease processes which may interrupt it to cause an acquired Horner's syndrome is essential, particularly since Horner's syndrome may be a manifestation of a life-threatening condition. CASE REPORT S ; : Four patients with acquired Horner's syndrome resulting from various etiologies are presented. The first case is a 41 year old male with a history of central retinal artery occlusion and third-order Horner's syndrome caused by a dissecting internal carotid artery aneurysm. The second patient is a 51 year old male with a Pancoast tumor and second-order Horner's syndrome initially presenting to his chiropractor with complaints of weakness and pain in the upper extremity. The third case is a 49 year old female with second-order Horner's syndrome caused by an enlarged thyroid gland who observed a mild ptosis in professional photographs taken several years previously. The fourth patient is a 70 year old male with secondorder Horner's syndrome and a history of a stellate ganglionectomy 47 years ago. CONCLUSIONS: Acquired Horner's syndrome may present to the optometrist as part of a constellation of signs and symptoms of an underlying systemic disease process. Recognition and thorough medical evaluation should be pursued to rule out life-threatening lesions. A review of the patient's history may reveal a causative medical condition or past surgical procedure which the patient may not have initially considered reporting to the optometrist, since the immediate relationship to the eyes may not be readily apparent to the layperson. ADDITIONAL COMMENTS: Dr. Shilla Patel: primary author Dr. Pauline Ilsen: secondary author corresponding author and levoxyl.

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