Horner Syndrome : Causes-Symptoms-Diagnosis-Treatment

 What Is Horner Syndrome?

Horner syndrome is a pretty uncommon disease characterized by using a constricted pupil (miosis), drooping of the upper eyelid (ptosis), absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity that protects the attention (enophthalmos). These are the four classic symptoms of the ailment.

The congenital, and greater rare, form of Horner syndrome is a gift at the beginning but the cause isn't acknowledged. Most often, Horner syndrome is received as a result of a few kinds of interference with the sympathetic nerves serving the eyes. The underlying causes can vary fairly, from a snake or insect chew to a neck trauma made by using a blunt device.

What Is Horner Syndrome?
Horner Syndrome

Horner’s syndrome, additionally known as oculosympathetic palsy or Bernard-Horner syndrome, is an especially uncommon condition that affects the eyes and part of the face. It occurs due to a disruption of the pathway of the sympathetic nerves that connect the brainstem to the eyes and face. These nerves control involuntary capabilities, which include dilation and constriction of the students of the attention and perspiration.

Usually, signs and symptoms related to Horner’s syndrome have an effect on the handiest one side of the face. Horner’s syndrome can arise in people of every age and both sexes. It can affect humans of all races and ethnic businesses.

The symptoms associated with Horner’s syndrome, in and of themselves, generally do no longer cause massive problems with a person’s fitness or vision. However, they can indicate the presence of an underlying health problem that may be very critical.

  1. Eye

  2. Cornea

  3. Iris

  4. Ciliary body

  5. Lens

  6. Retina

Medical terms

  • Horner syndrome is a condition that influences the face and eye on one side of the frame. It is due to the disruption of a nerve pathway from the mind to the head and neck.
  • Typically, signs and symptoms and symptoms of Horner syndrome encompass reduced scholar size, a drooping eyelid and reduced sweating at the affected side of the face.
  • Horner syndrome may be the result of another clinical trouble, together with a stroke, tumor or spinal twine damage. In a few instances, no underlying reason may be discovered. There's no specific treatment for Horner syndrome, but treatment for the underlying cause may additionally restore nerve characteristics.
  • Horner syndrome is likewise called Bernard-Horner syndrome or oculosympathetic palsy.
  • Horner syndrome is an unprecedented condition classically imparted with partial ptosis (drooping or falling of upper eyelid), miosis (constricted scholar), and facial anhidrosis (lack of sweating) due to a disruption inside the sympathetic nerve delivery. It is by and large obtained following harm to the sympathetic nerve delivery, but rare cases of congenital paperwork were visible. Therefore, remedy is focused around identifying and appropriate management of the underlying secondary purpose.
  • The syndrome has several names, consisting of Bernard-Horner syndrome (French-speaking countries), Horner syndrome (English speaking countries), oculosympathetic palsy, and Von Passow syndrome (Horner syndrome in affiliation with iris heterochromia).

The syndrome become first defined by using Francois Pourfour du Petit in 1727 when considering consequences from an animal experiment related to resection of intercostal nerves and next changes visible within the ipsilateral eye and face.[1] It changed into outlined greater very well by using the French physiologist Claude Bernard in 1852, observed by way of several physicians who presented exceptional interpretations.

Horner syndrome is a group of signs and symptoms that result from interruption of the sympathetic nerve supply to the eye The syndrome may be caused by trauma tumor infection or congenital malformation Sufferers typically have ptosis (drooping eyelid) decreased sweating of the face and miosis (pinpoint pupils) Other signs and symptoms such as enophthalmos (eye sunken into its socket) or lagophthalmos (eyelid sagging) may also be present.

Horner syndrome is a defect of the sympathetic nervous system The sympathetic nervous system is responsible for the signs and symptoms of the fight or flight response These include increased heart rate increased blood pressure widening of the pupils dilation of bronchioles in the lungs constriction of blood vessels and reduced motility in the gastrointestinal tract.

The types of Horner’s syndrome

Three unique nerve pathways may be worried in Horner’s syndrome. The nerves from the brain do not travel along a direct direction to the eyes and face. They journey along three paths and disruption may additionally arise in any of these pathways.

First order (central) Horner's syndrome — The nerves from the hypothalamus within the mind lead down through the mind stem and spinal wire to the chest. Damage or obstruction of this nerve pathway might also occur because of:

  • Sudden interruption of the blood flow to the brain stem

  • Tumor of the hypothalamus

  • Spinal cord lesions

Second order (preganglionic) — The second stage of the nerve pathway leads from the chest to the top of the lungs and along the carotid artery of the neck. Conditions that could damage or impede the nerve pathway consist of:

  • Tumors in the upper part of the lung or chest cavity

  • Trauma to the neck or chest cavity due to surgery or accident

Third order (postganglionic) — The nerve direction travels from the neck to the middle ear and eye. Problems can also end result from:

  • Lesions of the carotid artery

  • Middle ear infections

  • Injury to the base of the skull

  • Migraine or cluster headaches

Symptoms Horner syndrome

The feature bodily signs and symptoms and signs associated with Horner syndrome usually affect the most effective one side of the face (unilateral). These include drooping top eyelid; shrunk scholar; dryness (loss of sweating) at the identical facet of the face (ipsilateral) because the affected eye; and retraction of the eyeball.

If the onset of Horner syndrome is before  years of age, the coloured portions of the eyes (irises) can be special colors (heterochromia iridis). In most cases, the iris of the affected facet lacks color (hypopigmentation).

Horner syndrome usually affects one aspect of the face. Common signs and signs and symptoms include:

  • A persistently small pupil (miosis)

  • A notable difference in pupil size between the two eyes (anisocoria)

  • Little or delayed opening (dilation) of the affected pupil in dim light

  • Drooping of the upper eyelid (ptosis)

  • Slight elevation of the lower lid, sometimes called upside-down ptosis

  • Sunken appearance of the affected eye

  • Little or no sweating (anhidrosis) on the affected side of the face

Signs and symptoms, specifically ptosis and anhidrosis, may be subtle and difficult to hit upon.


Additional signs and signs and symptoms in kids with Horner syndrome can also include:

  • Lighter iris color in the affected eye of a child under the age of 1

  • Change in color on the affected side of the face that would typically appear from heat, physical exertion or emotional reactions

When to see a doctor

A wide variety of things, some more serious than others, can motivate Horner syndrome. It is essential to get a prompt and correct analysis.

Get emergency care if signs and symptoms or signs related to Horner syndrome appear all at once, seem after a annoying damage, or are observed through other signs or signs and symptoms, including:

  • Impaired vision

  • Dizziness

  • Slurred speech

  • Difficulty walking

  • Muscle weakness or lack of muscle control

  • Severe, sudden headache or neck pain

Causes Horner syndrome

Horner syndrome is due to damage to a certain pathway in the sympathetic frightened gadget. The sympathetic fearful gadget regulates heart price, scholar size, perspiration, blood strain and different features that allow you to reply fast to adjustments in your surroundings.

The nerve pathway tormented by Horner syndrome is split into three organizations of nerve cells (neurons).

The fashionable cause of Horner’s syndrome is damage to the nerve pathway between the mind and the face in what's referred to as the sympathetic frightened machine. This fearful system controls many things, including pupil length, coronary heart rate, blood pressure, sweat, and others. This gadget permits your body to respond efficiently to any modifications inside the environment around you.

There are 3 unique sections of the pathway, referred to as neurons, that can be damaged in Horner’s syndrome. They are known as first-order neurons, 2nd-order neurons, and 1/3-order neurons. Each element has a distinctive set of possible reasons for the damage.

First-order neurons

This neuron pathway leads from the hypothalamus at the base of the brain, passes through the brainstem and extends into the top part of the spinal cord. Problems in this region that may disrupt nerve feature associated with Horner syndrome include:

  • Stroke

  • Tumor

  • Diseases that cause the loss of the protective sheath on neurons (myelin)

  • Neck trauma

  • Cyst in the spinal column (syringomyelia)

Second-order neurons

This neuron direction extends from the spinal column, throughout the upper part of the chest and into the facet of the neck. Causes related to nerve damage in this place may additionally encompass:

  • Lung cancer

  • Tumor of the myelin sheath (schwannoma)

  • Damage to the main blood vessel leading from the heart (aorta)

  • Surgery in the chest cavity

  • Traumatic injury

Third-order neurons

This neuron direction extends alongside the aspect of the neck and leads to facial pores and skin and muscle groups of the iris and eyelids. Nerve damage on this location may be related to the following:

  • Damage to the carotid artery along the side of the neck

  • Damage to the jugular vein along the side of the neck

  • Tumor or infection near the base of the skull

  • Migraines

  • Cluster headaches, a disorder that results in cyclical patterns of severe headaches


The most not unusual reasons of Horner syndrome in youngsters encompass:

  • Injury to the neck or shoulders during delivery

  • Defect of the aorta present at birth

  • Tumor of the hormonal and nervous systems (neuroblastoma)

Unknown causes

In some cases, the cause of Horner syndrome can not be identified. This is known as idiopathic Horner syndrome.

How long does it take for Horner's syndrome to go away?

Horner's syndrome is a condition in which the sympathetic nerve to the eye is damaged The result of this damage is that because pupils are controlled by the sympathetic nerves only one pupil will react to light One half of the face will droop and there may be some decreased sweating on the half of the face where the sympathetic nerve is damaged The symptoms vary from person to person but most people report that it does not interfere with their vision.

What nerve is damaged in Horner's syndrome?

The sympathetic nervous system which helps regulate our internal organs is damaged in Horner's syndrome When this occurs we lose our ability to control certain muscles in the face and neck region that are controlled by the sympathetic nervous system As a result the eyelids droop and the pupil of each eye is constricted (pinpoint) when exposed to light This condition is most commonly caused by stroke or trauma to the sympathetic nerve bundle that begins at the brainstem and runs through the cervical spine It can also occur as a result of congenital birth defects.

Can a baby be born with Horner's syndrome?

Horner's syndrome results from damage to the sympathetic nervous system during surgery trauma or birth In infants Horner's syndrome is most commonly caused by a blockage of the carotid artery in the neck that supplies blood to the face and head.

Can you fix Horner's syndrome?

Horner’s syndrome is caused by an injury to the brainstem It can affect one or both eyes and may cause miosis (constricted pupil) ptosis (drooping eyelid) and enophthalmos (sunken eye) Treatment for Horner’s syndrome depends on the underlying cause but surgery is sometimes required to correct the drooping eyelid.

Diagnosis Horner syndrome

Your doctor or an eye fixed health practitioner (ophthalmologist) can do exams to check for Horner syndrome.

They’ll do a physical examination and ask about your scientific records to find out in case you've had any contamination or harm that could have precipitated nerve harm. Then, they’ll position drops in your eyes to see how your students react.

Other checks might also show a boom, harm, or injury that would cause Horner syndrome.In addition to a preferred scientific exam, your health practitioner will probably conduct checks to decide the nature of your symptoms and pick out a probable cause.

Tests to confirm Horner syndrome

Your health practitioner may be capable of diagnosing Horner syndrome primarily based on your history and an assessment of your signs and symptoms.

An eye expert (ophthalmologist) may affirm an analysis by way of putting a medicated eye drop in both eyes — either a drop in an effort to dilate the pupil of a healthy eye or a drop a good way to constrict the pupil in a wholesome eye. By evaluating the reactions inside the wholesome eye with that of the suspect eye, the health practitioner can determine whether nerve damage is the purpose of issues inside the suspect eye.

Tests to identify the site of nerve damage

The nature of your symptoms may help your physician slender the look for the purpose of Horner syndrome. Your physician may additionally conduct additional assessments or order imaging assessments to locate the lesion or irregularity disrupting the nerve pathway.

Your medical doctor can also administer a form of eye drop so that it will significantly dilate the healthful eye and little dilation of the affected eye if Horner syndrome is because of a third-order neuron irregularity — a disruption somewhere in the neck or above.

Your health practitioner might also order one or more of the following imaging assessments to discover the website online of a likely irregularity causing Horner syndrome:

Treatment Horner syndrome

The treatment of Horner syndrome depends on the area and purpose of the lesion or tumor. In some instances surgical removal of the lesion or boom may be appropriate. Radiation and chemotherapy may be beneficial to sufferers with malignant tumors.

Genetic counseling may be of benefit for sufferers and their families in the event that they have the genetic form of this sickness. Other remedies are symptomatic and supportive.

There's no specific remedy for Horner syndrome. Often, Horner syndrome disappears whilst an underlying medical situation is efficaciously treated.

Preparing for your appointment

In most nonemergency conditions, you commonly start by seeing a circle of relatives, doctor or an (ophthalmologist). You may be referred to a medical doctor who focuses on frightened device issues (neurologist) or a consultant in both neurological disorders and issues affecting the eye and visual pathways (neuro-ophthalmologist).

What you can do

Before your appointment, make a list that includes the subsequent:

  • Your symptoms, including any changes that cause you concern

  • Key personal information, including past and recent illnesses and injuries as well as any stresses in your life

  • All medications, vitamins or other supplements you take, including the doses

  • Questions to ask your provider

Take a member of the family or friend alongside, if feasible, to help you don't forget the statistics you're given.

Basic inquiries to ask your issuer consist of:

  • What's likely causing my symptoms?

  • Other than the most likely cause, what are other possible causes for my symptoms?

  • What tests do I need?

  • Is my condition likely temporary or chronic?

  • What's the best course of action?

  • Will I need any follow-up tests or evaluation?

If possible, carry some surprisingly current snapshots — ones that were taken earlier than the onset of signs and symptoms — to your appointment. These photographs may also assist your medical doctor investigate the current circumstance of your affected eye.

  1. Rehabilitation of Vision

What to expect from your doctor

Your medical doctor is able to take a history of your signs and symptoms and behavior in a fashionable clinical exam. He or she is likely to invite you some of questions, which includes:

  • When did you begin experiencing symptoms?

  • Have the symptoms changed or worsened over time?

  • Do you have a history of cancer?

  • Have you experienced any recent injury or trauma?

  • Have you experienced any head, neck, shoulder or arm pain?

  • Do you have a history of migraines or cluster headaches?

General summary

  1. Horner's syndrome is a disorder of the nervous system that can affect one or both eyes The cause of Horner's syndrome is not clearly understood However it appears to result from prolonged irritation of the nerve that runs from the brain to the eye In this condition the affected eye will have: A small pupil (the dark center of the eye) It looks like a keyhole A drooping upper eyelid The edge of the eyelid closest to the nose may look red and swollen No apparent reddening of the iris (the colored part of the eye) or sclera (the white part of the eye).

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