Iatrogenic Bilateral Sequential Ocular Sympathetic (Horner Syndrome) Turned Bilateral Parasympathetic Pupil Involvement Associated with Long Coronavirus-Related Dysautonomia: A Case Report.
Celeste Yiqi Wang, Jennifer K Dunnigan, Elizabeth O Arogundade, Sanjana Jaiswal, Kenneth C Lao, Andrew G Lee
{"title":"Iatrogenic Bilateral Sequential Ocular Sympathetic (Horner Syndrome) Turned Bilateral Parasympathetic Pupil Involvement Associated with Long Coronavirus-Related Dysautonomia: A Case Report.","authors":"Celeste Yiqi Wang, Jennifer K Dunnigan, Elizabeth O Arogundade, Sanjana Jaiswal, Kenneth C Lao, Andrew G Lee","doi":"10.1159/000550937","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This report presents an unusual case of sequential, pharmacologically confirmed iatrogenic bilateral Horner syndrome followed by bilateral Adie's tonic pupil, highlighting the spectrum of ocular dysautonomia associated with long coronavirus disease 2019 (COVID-19).</p><p><strong>Case presentation: </strong>A 41-year-old woman with a history of coronavirus disease 2019 reinfection and multiple comorbidities developed pharmacologically confirmed bilateral Horner syndrome after bilateral stellate ganglion blocks. Subsequent worsening of long COVID-19 symptoms alongside systemic dysautonomia emerged, including postural orthostatic tachycardia syndrome, orthostatic hypotension, and mast cell activation syndrome. The patient then presented with bilateral, poorly reactive, enlarged pupils, and light-near dissociation. Bilateral Adie's tonic pupil was pharmacologically confirmed. Neuroimaging and laboratory workup were unremarkable.</p><p><strong>Conclusion: </strong>As more cases of long COVID-19 emerge, physicians should be aware that long COVID-19 can manifest with rare neuro-ophthalmic presentations, including bilateral pupillary autonomic dysfunction.</p>","PeriodicalId":9635,"journal":{"name":"Case Reports in Ophthalmology","volume":"17 1","pages":"934-941"},"PeriodicalIF":0.6000,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609167/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Case Reports in Ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000550937","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: This report presents an unusual case of sequential, pharmacologically confirmed iatrogenic bilateral Horner syndrome followed by bilateral Adie's tonic pupil, highlighting the spectrum of ocular dysautonomia associated with long coronavirus disease 2019 (COVID-19).
Case presentation: A 41-year-old woman with a history of coronavirus disease 2019 reinfection and multiple comorbidities developed pharmacologically confirmed bilateral Horner syndrome after bilateral stellate ganglion blocks. Subsequent worsening of long COVID-19 symptoms alongside systemic dysautonomia emerged, including postural orthostatic tachycardia syndrome, orthostatic hypotension, and mast cell activation syndrome. The patient then presented with bilateral, poorly reactive, enlarged pupils, and light-near dissociation. Bilateral Adie's tonic pupil was pharmacologically confirmed. Neuroimaging and laboratory workup were unremarkable.
Conclusion: As more cases of long COVID-19 emerge, physicians should be aware that long COVID-19 can manifest with rare neuro-ophthalmic presentations, including bilateral pupillary autonomic dysfunction.
期刊介绍：
This peer-reviewed online-only journal publishes original case reports covering the entire spectrum of ophthalmology, including prevention, diagnosis, treatment, toxicities of therapy, supportive care, quality-of-life, and survivorship issues. The submission of negative results is strongly encouraged. The journal will also accept case reports dealing with the use of novel technologies, both in the arena of diagnosis and treatment. Supplementary material is welcomed. The intent of the journal is to provide clinicians and researchers with a tool to disseminate their personal experiences to a wider public as well as to review interesting cases encountered by colleagues all over the world. Universally used terms can be searched across the entire growing collection of case reports, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
