Horner's Syndrome: Causes and Manifestations

What is Horner's syndrome?

Horner's Syndrome

Have you ever heard about the combination of ptosis, miosis and anhydrosis? This is what called Horner's syndrome. In Horner's syndrome, your eyelid droops, your pupil gets small in size and you cannot sweat on the affected side of your face! 

How does Horner's syndrome occur?

Horner’ syndrome occurs due to interruption or damage to the sympathetic fibers [1,3]. The postganglionic sympathetic fibers for the eye originate in the superior cervical ganglion and travel along the carotid and ophthalmic arteries and supply dilator papillae, tarsal muscle of upper eyelid and orbital muscle which tends to hold the eyeball forward. Some fibers also supply the face’s sweat glands.The interruption of sympathetic fibers may take place at many levels: at brain stem (demyelination, vascular disease), cord (syringomyelia), and thoracic outlet (Pancoast’s tumor) or on the sympathetic nerve’s trip on the carotid artery into the skull (carotid artery aneurysm) and thence to the orbit.

What are the manifestations of Horner's syndrome?

Manifestations of Horner’s syndrome develop when damage to the sympathetic fibers take place. The following manifestations are seen on the side of the lesion:

• Drooping of eyelid (Ptosis) [2,3]
• Small pupil (Miosis)
• Sunken eye (Endophthalmos)
• Loss of sweating of the face on the side of lesion (Anhidrosis) [3]

The patient’s with Horner’s syndrome may experience flushing on the affected side of the face because of dilated vessels under the skin. In children, the interruption to the sympathetic ganglion may cause difference in the colors of the two eyes [1]. 

Horner’s syndrome is known with many other names like Horner syndrome, Bernard-Horner syndrome or as oculosympathetic palsy. 

Reference

1. Lonmore M, Wilkinson I, Turmezei T, Cheung CK. Lumps in the neck: Oxford handbook of clinical medicine 7^th Ed. New York: Oxford university press 2007; 620.
2.  Ropper AH, Brown RH (2005). "14: disorders of ocular movement and pupillary function". In Ropper AH, Brown RH. Adams and Victor's Principles of Neurology (8th Ed.). New York: McGraw-Hill Professional. pp. 222–45. 
3. Nasir SA, Inayatullah M. Methods of Clinical Examination: Bedside Techniques 3^rd Ed. Multan: Saira Publishing 2006; 203

Next Post

Keywords: Horner syndrome, Bernard-Horner syndrome, Oculosympathetic palsy, Causes, Treatment