Dr. Falkenberry is a senior resident in ophthalmology at the VA Eastern Colorado Health Care System (ECHCS) in Denver and the University of Colorado Denver School of Medicine in Aurora. Dr. Pelak is a staff physician at the VA ECHCS and an associate professor of neurology and ophthalmology at the University of Colorado Denver School of Medicine.
When the clinical signs of this syndrome leave some doubt, pharmacologic testing helps confirm the diagnosis. These two cases illustrate the potential for apraclonidine to replace the more traditional, but problematic, topical cocaine in this capacity.