United Brachial Plexus Network, Inc.

My daughter, Zoe, is 2 years old. Her right arm is affected by a BPI. She is responding to therapy well, and we are currently in a study regarding the effects of Botox. I am really optomistic about this treatment as is her doctor.

Anyway, my reason for writing...the other day I noticed in a couple of pictures Zoe's eyes look funny. The eye on her BPI side seems a little droopy. I can't tell looking at her if they are different or not, so I feel wierd asking the Doctor about it. I will ask anyway, I just wanted to be a little more prepaired. I am not sure if I need to ask the neurologist, or just her regular Doc. Anyone else have this problem? Do you know of any studies that have been done regarding this? Any advice would be appreciated...Thanks
Melissa

I would ask whichever doctor is more experienced with BPI. It sounds like it might be Horner's syndrome, which includes a droopy eyelid, differences in sweating on the affected side, and pupil size and dilation differences. I would tend to think your neurologist would know more about it, but not necessarily. It is from an area of the spinal cord being damaged by trauma to the lower roots of the brachial plexus.

However, a droopy eye only (without the other symptoms) can apparently be a result of upper trunk brachial plexus injury, too. Our son only had the droopy eyelid, and he didn't have significant lower root involvement in his BPI. We were told that the droopy eyelid by itself can be from injury up around C4.

I don't know of any studies that have been done on either version.

Kate

Hi Melissa,

My son was diagnosed with Horner's Syndrome. He is now 3 1/2 and for the most part it has resolved, except for when he is sick or just very tired. My son's was confirmed by a neurologist and a pediatric ophthalmologist, interestingly no bpi specialist ever caught it or even mentioned it and it was very apparent when he was younger. I would think either one of those doctors could help you decipher if the droopy eyelid is related to Horner's or not.

There really is no particular testing that is done, usually just an examination by the doctor will suffice. They are generally looking for the droopy eyelid, which isn’t simply due to hereditary, and a dilation lag, meaning the involved pupil will dilate slowing in dim illumination. Usually you would be able to notice two different sized pupils. There isn’t really anything they do to treat it, at least not if it is Horner’s related to the bpi injury.

I would guess there is a good chance that it is Horner's, especially since it is on the injured side dilation. Do you really notice it in younger pictures? Does it get worse when she is sick or tired?

Lisa

I have to tell you, when my baby had Botox, she responded poorly to it. It didn't "agree" with her. It didn't cause any major problems, but it did effect her eyes for a period of close to 2-3 months. After that period passed everything was back to normal. It was pretty bizarre. My doctor told us it is something that can commonly happen with Botox, as did 3 additional BPI specialists. Hope this helps. Look back at pictures before the Botox to see how her eyes looked then. Let us know, please, as this is very interesting.

I had a bad Horner's after my accident, and the eye looked noticeably strange for years. It's still there now but nowhere near as bad, it does affect my night driving as the pupil never dilates fully.
The funny thing is, I noticed my daughter has a slight droopy eyelid so I tested her pupil dilation and it was abnormal. She does not have a bpi. When I was looking thru old family photo albums I noticed it in several of my relatives, including my Dad. Since then I have found out that Horner's is associated with many other conditions (ie it's not just a bpi thing) and it is also thought in some cases to be hereditary, in my family it seems to be. Looking at photos of me pre tbpi, I didn't have it, or not noticeably, so it's quite funny that I do now!

My daughter has a milder case of Horner's. We notice it mostly in pictures and when she gets tired. Our neurologist noticed it before we did. Though the Horner's doesn't really effect vision per se, it does have a negative effect on periferal vision.

As for Botox and the eyes..we did 2 rounds of Botox (both with great results) and never had an eye problem with it.

claudia

Melissa,

I have Horner's from my injury also. I have trouble with the eye feeling like there is something foreign under the eyelid. It really hurts! The Opthamologist told me to get the artificial tears in gel form, that the eye is getting extremely dry and needs artificial tears. So if you notice your little one rubbing that eye a lot, you might want to ask the Dr about using the tears gel. It helps me.

SusieKaye

Hi there,

My son has a bpi due to a motorbike accident a little over a year ago. I too have noticed his eye on the side of the injury is what I would describe as a little lob-sided. In the begining it was really noticeable but over the course of the year it seems to have straighted somewhat.
If and when you do ask your doctor I would be interested in his reply. perhaps you can keep us posted

I noticed in pictures of Sophie that her eyes did not seem to be focused on the same thing. Since it didn't happen consistently, I took the picture with me to the doctor so he could see for himself. We were recommended to go to a pediatric opthalmologist - we will see her Thurs.
Tina