A 60 years old male with past medical history of dyslipidemia, cervical spondylosis and right rotator cuff tear presented to the emergency room for evaluation of right eye drooping and miosis. Patient underwent right rotator cuff repair surgery two days prior to presentation. He developed right partial ptosis, miosis and blurry vision 7 hours after the surgery. His symptoms persisted throughout the following day, so he was referred to ophthalmology by his PCP, then he was sent to the emergency room. He had mild right flank pain with cough, denied any neck pain, chest pain, focal numbness or weakness. On physical examination: right upper lid partial ptosis, right lower lid elevation; anisocoria (left>right), more asymmetrical at dim light, the remainder of the neurological exam was unremarkable. His CT head, CTA head/neck, CT chest and brain MRI were all unremarkable for any structural pathology. Carotid dissection, Pancoast tumor, cerebral vascular etiology and other intracerebral etiology were ruled out. Horner syndrome resolved completely at postoperative day 3.
Reviewing the patient chart, right shoulder arthroscopic shoulder rotator cuff repair was performed under general anesthesia with interscalene block by interscalene catheter.