Correspondence

Medical Mystery: Brown Eye and Blue Eye — The Answer

N Engl J Med 2005; 353:2409-2410December 1, 2005

Article

To the Editor:

The Medical Mystery in the October 6 issue1 shows a 10-year-old boy with one brown and one blue eye, with mild ptosis and miosis of the lighter, left eye (Fig. 1Figure 1One Brown Eye and One Blue Eye.). Both eyes respond equally to light and have normal vision; both are normal on funduscopic examination. The eyes of the boy's father are blue, and the mother's are gray. At 10 months of age, the boy was given a diagnosis of a left-sided paraspinal neuroblastoma (C7), extending to the upper thoracic vertebrae and entering the intraspinal canal, with bone marrow involvement (stage 4). After undergoing emergency decompression, chemotherapy, and surgery, the boy is in complete remission but has a loss of sweating (anhidrosis) on the left side of the face and torso. This finding is compatible with left Horner's syndrome, a regional disturbance of the sympathetic nervous system caused by the paravertebral tumor. A unilateral lack of sympathetic stimulation in childhood interferes with melanin pigmentation of the melanocytes in the superficial stroma of the iris, resulting in heterochromia. This clinical finding might be useful in the early diagnosis of lesions affecting the sympathetic nerves.

Benjamin Gesundheit, M.D., Ph.D.
Mark Greenberg, M.D.
Hadassah University Hospital, 91120 Jerusalem, Israel

1 References

1. 1

   Gesundheit B, Greenberg M. Medical mystery -- one brown eye and one blue eye. N Engl J Med 2005;353:1502-1502
   Full Text | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Peter Greaves. 2012. Nervous System and Special Sense Organs. , 799-866.
   CrossRef

2. 2

   Dimitrios I. Zafeiriou, Marina Economou, Dimitrios Koliouskas, Panagiota Triantafyllou, Panagiotis Kardaras, Nikos Gombakis. (2006) Congenital Horner's syndrome associated with cervical neuroblastoma. European Journal of Paediatric Neurology 10:2, 90-92
   CrossRef