Horner’s syndrome affects one side of the face. The following are the signs and symptoms experienced by individuals suffering from this syndrome:

• Onset of miosis, a condition wherein there is decrease in the size of the pupil.
• Anisocoria, wherein there is considerable difference between both pupils.
• Delayed dilation of pupil in dim light.
• Onset of upside down ptosis, a condition characterized by elevation of lower eye lid.
• Dropping eye lids, especially the upper one.
• Affected side experiences little or no sweating.
• Children affected by Horner’s syndrome, do not experience the flushing or redness of face in the affected side as one would normally experience after exposure to heat or after physical exertion. In addition, the color of the iris in affected children is lighter than the normal eye [6].

• Weakness

  Dissociated sensory loss: lost pain and temperature sensation, but preserved light touch, vibration and proprioception Cape-like distribution of pain Hand weakness Bowel and bladder incontinence, sexual dysfunction Spinal injury or infarction Weakness [derangedphysiology.com]

  From Wikidata Jump to navigation Jump to search Human disease characterized by miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhydrosis (decreased sweating), with apparent enophthalmos (inset eyeball) Bernard Horner syndrome [wikidata.org]

  Apraclonidine is primarily an α2-receptor agonist, but it does have some weak α1 affinity, as evidenced by conjunctival blanching. [jamanetwork.com]

• Fatigue

  The labor and delivery were uncomplicated except for maternal fatigue and insufficient pushing, resulting in vacuum-assisted vaginal delivery. The patient's medical [jamanetwork.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 28, 2019 [patientslikeme.com]

  The patient reports that her cough has not resolved and feels fatigued. Medical history is significant for hypertension and hyperlipidemia, which is currently being treated with hydrochlorothiazide and atorvastatin. [step1.medbullets.com]

• Goiter

  A 36-year-old Sri Lankan Sinhalese woman developed unilateral partial ptosis with enophthalmos and myosis one week after total thyroidectomy for a benign multinodular goiter. A clinical diagnosis of Horner's syndrome was made. [ncbi.nlm.nih.gov]

  […] hypothalamic, thalamic or brainstem ischemia (e.g. lateral medullary syndrome ) hemorrhage tumor demyelination Pre-ganglionic causes apical lung mass/tumor ( Pancoast tumor ) cervical rib cervicothoracic spine trauma brachial plexus injury thyroid mass/ goiter [radiopaedia.org]

  The most common triggers of Hunter’s syndrome include: Cluster headaches Damage to the carotid artery Damage to the aorta Damage to the jugular vein Migraines Schwannoma (tumor in the myelin sheath) Thoracic surgery Lung cancer Traumatic injuries Goiter [birthinjuryguide.org]

  According to the team of investigators, the causes varied widely from those that were benign including idiopathic and surgical causes, cluster headache, and goiter to the neurologically or systemically dangerous causes that included carotid artery dissection [ophthalmologytimes.com]

• Asymptomatic

  We describe a unique case of a rhabdomyosarcoma of the middle ear cavity in a four-year-old boy, presenting as an otherwise asymptomatic ipsilateral Horner's syndrome. [ncbi.nlm.nih.gov]

  Presentation May be asymptomatic. Symptoms [ 2 ] Inability to open eye fully on the affected side. Loss of sweating on the affected side. Facial flushing (if preganglionic lesion). Orbital pain/headache (if postganglionic lesion). [patient.info]

  Horner's syndrome secondary to asymptomatic pneumothorax in an adolescent. Eur J Pediatr 2007;166 (5) 507- 508 PubMed Google Scholar Crossref 3. Slavin ML Horner syndrome with equal-sized pupils in a case underlying physiologic anisocoria. [jamanetwork.com]

• Collapse

  Further, its presence makes a tensioning pneumothorax, or as in this case a pneumothorax with significant collapse and apical adhesions, more likely. [ncbi.nlm.nih.gov]

  […] carotid dissection, tuberculosis, Pancoast tumor (a tumor in the upper end of the lung), brain tumors, spinal cord injury in the neck, trauma to the cervical or thoracic portions of the spinal cord, cluster migraine headache, vertebrae destruction or collapse [encyclopedia.com]

  However, despite their good evolution, the presence of the syndrome tells us of a sympathetic block that reaches thoracic levels with a potential risk of cardiorespiratory collapse. [scielo.org.co]

• Dysphagia

  V, IX and X cranial nerve lesions Cavernous sinus pathology An associated sixth nerve palsy Everything in the cavernous sinus may have been taken out (that being upper facial branches of the 5th nerve, the 4th nerve and the 3rd nerve) Syringobulbia Dysphagia [derangedphysiology.com]

  This commonly presents as Horner’s with ipsilateral ataxia, dysphagia, hoarseness and reduced gag reflex.5 Second-order The second-order neuron leaves the spinal cord and travels towards the head via the cervical sympathetic chain. [geekymedics.com]

  A 25-year-old woman presented with upper oesophageal dysphagia and a well-demarcated left parapharyngeal mass displacing the great vessels laterally and posteriorly. The mass was resected via an exploratory neck incision. [ncbi.nlm.nih.gov]

  This features dysphagia, analgesia in ipsilateral face and contralateral trunk and extremities, ipsilateral cerebellar ataxia, and rotary nystagmus; skew deviation may occur, with vertical diplopia. [eyes.gp-surgery.com]

  Restiform body, cerebellum Ipsilateral Gait ataxia Restiform body, cerebellum Ipsilateral Nystagmus Vestibular nucleus Ipsilateral Nausea / vomiting Vestibular nucleus Ipsilateral Vertigo Vestibular nucleus Ipsilateral Horseness Nucleus ambiguus Ipsilateral Dysphagia [strokecenter.org]

• Nausea

  […] loss – face – pain and temperature CN 5 nucleus Ipsilateral Facial pain CN 5 nucleus Ipsilateral Ataxia – arm and leg Restiform body, cerebellum Ipsilateral Gait ataxia Restiform body, cerebellum Ipsilateral Nystagmus Vestibular nucleus Ipsilateral Nausea [strokecenter.org]

  These may include: Vertigo (sensation that surroundings are spinning) with nausea and vomiting Double vision Lack of muscle control and coordination Arm pain, weakness and numbness One sided neck and ear pain Hoarseness Hearing loss Bladder and bowel [nlm.nih.gov]

• Hiccup

  Ipsilateral Vertigo Vestibular nucleus Ipsilateral Horseness Nucleus ambiguus Ipsilateral Dysphagia Nucleus ambiguus Ipsilateral Horner syndrome Descending sympathetics Contralateral Hemisensory loss – pain and temperature Spinothalamic tract Neither Hiccups [strokecenter.org]

  […] which is an infarction of the lateral medulla, patients can present with a Horner syndrome in addition to nystagmus, skew deviation, ataxia, ipsilateral sensory loss on the face, and contralateral hemisensory loss on the body, dysphagia, hoarseness, hiccups [eyerounds.org]

• Hypertension

  Iatrogenic Horner's syndrome is a rare complication that can occur after trauma, cervical central line insertion, chest tube insertion, and rarely following adult thoracic and neck surgery, especially in high risk patients with hypertension and diabetes [ncbi.nlm.nih.gov]

  Hypertensive encephalopathy after bilateral carotid endarterectomy. Stroke 1995 ; 26: 488 – 91 Google Scholar | Crossref | Medline 3. Ejaz, AA, Meschia, JF. [doi.org]

  Medical history is significant for hypertension and hyperlipidemia, which is currently being treated with hydrochlorothiazide and atorvastatin. She also has a 30 pack-year smoking history. [step1.medbullets.com]

  […] lens implant Pars plana vitrectomy with removal of epiretinal membrane of the right eye Past Medical History: Sleep apnea - CPAP compliant Hypertension Ocular Medications: Prednisolone acetate 1% ophthalmic suspension, left eye daily Dorzolamide-timolol [eyerounds.org]

• Arthralgia

  Lyme disease in North America, where it is a known cause of acute and delayed musculoskeletal and neurologic disease (Figure 4).3 Approximately 68% of patients with early Lyme disease present with systemic viral-like symptoms, most commonly fatigue, arthralgia [jabfm.org]

• Anhidrosis

  A useful way to differentiate the location of the lesion is to assess the sites affected by anhidrosis: Anhidrosis of face, arm and trunk: central/first order Anhidrosis of face: second-order No anhidrosis: third-order First-order (central Horner’s) The [geekymedics.com]

  Other signs Anhidrosis: Variable degree of loss of sweating can be seen depending on the site of the lesion. Central or preganglionic lesions tend to produce more noticeable anhidrosis. [eyewiki.aao.org]

  Central or preganglionic lesions tend to produce more noticeable anhidrosis. The sudomotor and vasomotor fibers to most of the face separate out at the superior cervical ganglion and anhidrosis is often not noticeable in postganglionic lesions. [eyewiki.org]

  He presented changes in facial skin colouration after exercise: the left side of his face was flushed and sweaty, whereas the right side was pale, showing anhidrosis. [elsevier.es]

• Decreased Sweating

  From Wikidata Jump to navigation Jump to search Human disease characterized by miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhydrosis (decreased sweating), with apparent enophthalmos (inset eyeball) Bernard Horner syndrome [wikidata.org]

  The signs of the syndrome occur on the same side as the lesion of the sympathetic trunk and include: a constricted pupil, a weak-droopy eyelid, apparent decreased sweating, and with or without inset eyeball. [ncbi.nlm.nih.gov]

  Decreased sweating on the affected side of the face, Drooping eyelid (ptosis), Sinking of the eyeball into the face, Small (constricted) pupil (the black part in the center of the eye) Treatment depends on the cause of the problem. [omicsonline.org]

• Hyperhidrosis

  METHODS: A prospective descriptive study of 25 patients (50 pupils) ranging in age from 18 to 40 years with an indication of T3 sympathectomy for palmar hyperhidrosis or palmar-plantar hyperhidrosis from 1 December 2009 to 31 December 2010 was carried [ncbi.nlm.nih.gov]

  Hyperhidrosis as a reflection of autonomic failure in patients with acute hemispheral brain infarction. Stroke.1992; 23:1271-1275. CrossrefMedlineGoogle Scholar 22 Kneisly LW. Hyperhidrosis in paraplegia. Arch Neurol.1977; 34:536-539. [ahajournals.org]

  Hyperhidrosis as a reflection of autonomic failure in patients with acute hemispheral brain infarction. Stroke. 1992 ; 23 :1271-1275. Crossref Medline Google Scholar 22 Kneisly LW. Hyperhidrosis in paraplegia. Arch Neurol. 1977 ; 34 :536-539. [stroke.ahajournals.org]

  […] dilation/distention of hollow organ) Trauma Orbital apex and skull base tumours Cavernous sinus tumours Herpes zoster/shingles Lyme disease Granulomatosis with polyangititis (blood vessel disease) Temporal arteritis Signs 3,4 : postsympathectomy facial hyperhidrosis [optometrystudents.com]

• Miosis

  Case 2 showing miosis prior to apraclonodine hydrochloride, 0.5%, testing. Figure 6. Case 2 showing reversal of miosis 30 minutes after administration of apraclonodine hydrochloride, 0.5%. [jamanetwork.com]

  Left-sided Horner’s syndrome with ipsilateral ptosis and miosis.3 Horner’s can arise an isolated injury or as a manifestation of a systemic disease process.2 This article will cover the classification and causes of Horner’s syndrome. [geekymedics.com]

  Horner syndrome classically manifests as ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis [ 1, 2 ]. [doi.org]

  Clinical diagnosis Horner’s syndrome is diagnosed clinically by observing ptosis (of upper and lower lids), miosis of the ptotic eye and demonstration of dilation lag in the affected eye. [eyewiki.org]

  Horner’s syndrome (also called oculosympathetic paresis, or Horner syndrome) comprises a constellation of clinical signs including the classic triad of ptosis, miosis, and anhidrosis. [eyewiki.aao.org]

• Anisocoria

  Clinically the anisocoria reversal, even when slight, was easily detected with the naked eye. [jamanetwork.com]

  Pupils : Patients have anisocoria (difference in the pupillary size) with the ptotic eye having the smaller pupil (miosis). The anisocoria is more prominent in the dark indicating pathology of the pupillary dilator. [eyewiki.org]

  Pupils: Patients have anisocoria (difference in the pupillary size) with the ptotic eye having the smaller pupil (miosis). The anisocoria is more prominent in the dark, indicating pathology of the pupillary dilator. [eyewiki.aao.org]

• Enophthalmos

  Unfortunately, the authors perpetuate the extremely common misconception that enophthalmos accompanies ptosis and miosis in human Horner Syndrome. It is only an illusion of enophthalmos caused by the ptosis. [doi.org]

  From Wikidata Jump to navigation Jump to search Human disease characterized by miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhydrosis (decreased sweating), with apparent enophthalmos (inset eyeball) Bernard Horner syndrome [wikidata.org]

  Horner (1831 to 1886), Swiss anatomist Synonyms: Horner's trias, Horner's complex, Horner's symptom complex, oculopupillary syndrome German : Horner-Syndrom 1 Definition The Horner's syndrome is a combination of symptoms consisting of miosis, ptosis and enophthalmos [flexikon.doccheck.com]

• Blepharoptosis

  Supplementary video [emermed-2021-211257supp001.MOV] Figure 1 Examination revealed right-sided Horner syndrome, with right-sided partial blepharoptosis and pupillary miosis. [emj.bmj.com]

  This case study reports a 7-year-old boy with right miosis, mild blepharoptosis, and iris hypopigmentation detected in a routine pediatric follow-up without ipsilateral facial anhydrosis, flushing, or pain. [ncbi.nlm.nih.gov]

  Subject Anisocoria; Blepharoptosis; Carotid Artery Diseases; Carotid Artery Injuries; Chile; Horner Syndrome; Humans; Magnetic Resonance Imaging; Male; Miosis; Palate, Soft Abstract A 7-year-old boy developed a Horner's syndrome after falling on a stick [collections.lib.utah.edu]

  Horner syndrome classically presents as an ipsilateral enophthalmos, blepharoptosis, pupillary miosis and facial anhydrosis due to disruption at some point of the oculosympathetic pathway. [radiopaedia.org]

• Unilateral Ptosis

  A 17-year-old girl was admitted with a 1-year history of right-sided headaches and unilateral ptosis for 6 months. She was diagnosed with Horner's syndrome. [ncbi.nlm.nih.gov]

  Reference #2: Unilateral ptosis and miosis caused by pneumomediastinum Chipman et al. [journal.chestnet.org]

  Ptosis secondary to a Horner's syndrome can usually be distinguished from isolated congenital ptosis because of the associated ocular and adnexal findings. Infants present with unilateral ptosis but also with associated miosis. [webeye.ophth.uiowa.edu]

  Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis,. Download full- text PDF. Buckley SJ, Horner V, Wing T, Bird G. SINDROM HORNER Oleh: dr. [cirykoxuti.ga]

• Paresis

  Although Horner's syndrome has been reported with several disorders of the carotid artery, our case documents a rare iatrogenic oculosympathetic paresis after elective carotid endarterectomy. [ncbi.nlm.nih.gov]

• Nystagmus

  X cranial nerve lesions Cavernous sinus pathology An associated sixth nerve palsy Everything in the cavernous sinus may have been taken out (that being upper facial branches of the 5th nerve, the 4th nerve and the 3rd nerve) Syringobulbia Dysphagia Nystagmus [derangedphysiology.com]

  This features dysphagia, analgesia in ipsilateral face and contralateral trunk and extremities, ipsilateral cerebellar ataxia, and rotary nystagmus; skew deviation may occur, with vertical diplopia. [eyes.gp-surgery.com]

  Manifestation Comments Ipsilateral Sensory loss – face – pain and temperature CN 5 nucleus Ipsilateral Facial pain CN 5 nucleus Ipsilateral Ataxia – arm and leg Restiform body, cerebellum Ipsilateral Gait ataxia Restiform body, cerebellum Ipsilateral Nystagmus [strokecenter.org]

  Neurologic signs Neurologic signs may be present depending on the site of lesion Brainstem (bulbar) signs : ataxia, diplopia, nystagmus, lateralized weakness or numbness, hoarseness and dysphagia. [eyewiki.org]

  Neurologic signs Neurologic signs may be present depending on the site of lesion Brainstem (bulbar) signs: ataxia, diplopia, nystagmus, lateralized weakness or numbness, hoarseness and dysphagia. [eyewiki.aao.org]

• Mydriasis

  The sympathetic nervous system innervates three important structures in the eye: Dilator pupillae: involved in mydriasis or dilation of the pupil Superior tarsal (or Muller’s) muscle: aids in elevating the upper eyelid with the levator palpebrae superioris [geekymedics.com]

  Should denervation hypersensitivity develop, marked mydriasis will occur - even in minute concentrations of adrenaline, e.g. 1:1 000. [scielo.org.za]

  […] ptosis, the eyeball only seems to be sunk in) 4 Diagnostics The diagnostics normally adopted are visual diagnostics as a well as observation after administration of certain drugs ( cocaine equivalents), which usually causes a lack of, or alleviated, mydriasis [flexikon.doccheck.com]

  We performed apraclonidine test for the diagnosis of Horner’s syndrome, which produced mydriasis on the affected eye, while there was no significant change of the normal eye. [ncbi.nlm.nih.gov]

  This effect may be indirectly amplified by the absence of presynaptic α2-receptor activity, which normally down-regulates the release of norepinephrine into the synaptic junction and thus decelerates α1-stimulated mydriasis. [jamanetwork.com]

A general medical examination would be carried out in the preliminary stages, followed by other tests to identify the nature of the symptoms and exact cause behind development of Horner’s syndrome. Typically the following tests would be done:

• Eye examination: In this test, eye drops will be administered to both eyes; the pupil of the healthy eye will get dilated, whereas the eye drops will constrict the pupil of the affected eye. This will help in confirming the diagnosis of Horner’s syndrome.
• Imaging studies: Imaging studies such as CT scan, MRI and X-ray will be done in order to locate the site of nerve damage. A chest radiograph would provide insight about the development of apical bronchogenic carcinoma which is considered as one of the most potential causes of Horner’s syndrome. In addition, MRI of the brain and CT scan of the head are also indicated [7].
• Blood and urine tests would also form an important part of the diagnostic procedure and are done if children are suspected to be suffering from Horner’s syndrome. These tests are necessary to diagnose the presence of neuroblastoma [8].
• Pharmacologic testing: This method is very helpful in diagnosis of Horner’s syndrome. These include the topical cocaine test, topical apraclonidine test and topical hydroxyamphetamine test [9].

• Mediastinal Mass

  […] trauma brachial plexus injury thyroid mass/ goiter /tumor mediastinal mass tumor common carotid artery pathology injury to superior cervical ganglion Post-ganglionic causes internal carotid artery pathology dissection aneurysm carotid-cavernous fistula [radiopaedia.org]

  mass,5,13,14 or thoracic sympathectomy.1 Sympathetic innervation of the face and eyes comprises a 3-neuron chain and is represented in Fig. 3. [thejns.org]

  […] or trauma, breast cancer, mediastinal masses, neuroblastoma, schwannoma) 3rd order neuron Lesions in the superior cervical ganglion, carotid artery, cavernous sinus or superior orbital fissure (trauma, carotid artery dissections, aneurysms, herpes zoster [eyerounds.org]

There is no specific treatment regime for Horner’s syndrome. The major goal of treatment is to successfully treat the underlying disease condition, which would in turn help in appropriate management of the condition.

Surgical intervention may also be required when the carotid artery is involved. The types of surgical procedures indicated in treatment of Horner’s syndrome include neurosurgical procedures, and vascular surgical methods for aneurysm or dissection of the carotid artery [10].

The prognosis of the condition majorly depends on the underlying causative factor. If the underlying causative factor can be successfully treated, then the prognosis of Horner’s syndrome is usually favorable.

Horner’s syndrome occurs when certain groups of nerves of the sympathetic trunk are damaged. The sympathetic nerves are responsible for regulation of the heart rate, blood pressure, perspiration and size of the pupil. Injury or damage to the nerve fibers can stem from the following factors [2]:

• Injury to the carotid artery
• Individuals suffering from migraine [3]
• Development of tumor in the lungs
• Development of tumor in the brainstem
• Stroke
• Sympathectomy, wherein surgery is done to relieve pain by interrupting the nerve fibers
• Injury to the nerves of the brachial plexus
• In many instances, the cause of Horner’s syndrome is unknown and cannot be identified. Such a type of condition is then termed as idiopathic Horner’s syndrome.

Horner’s syndrome is a rare disorder affecting about 1 in 6250 newborns. The condition can also occur later in life; but the exact incidence in such cases is unknown [4].

Horner’s syndrome develops as a result of a lesion which occurs at any point in the pathway of the sympathetic trunk. Due to such a kind of phenomenon, all patients experience abnormalities such as ptosis, elevation of the lower eye lid, development of dilation lag and miosis and impaired flushing and sweating. The degree of severity of these abnormalities depends on the extent of damage to the nerve fibers.

Anatomically, 3 groups of nerves responsible for the sympathetic function of the eye are the first order, second order and third order neurons. The first order neurons travel from the hypothalamus to the cervical spine. The second order neurons travel from neck to the outer side of the spinal region. Lastly, the third order neurons, travel through the outer side of the spinal cord to the eye [5].

Prevention of Horner’s syndrome is geared towards preventing the onset of trigger factors. This would include prevention of trauma of the head, avoiding smoking and controlling various cardiovascular risk factors. All these approaches can help prevent the onset of Horner’s syndrome.

Horner’s syndrome is characterized by development of various kinds of signs and symptoms that occur as result of damage to the sympathetic trunk. Such a type of condition affects the face and eyes. This syndrome produces signs and symptoms that affect one side of the body where there is lesion of the sympathetic trunk. Horner’s syndrome causes decrease in the size of the pupil, drooping eyelid and reduced sweating particularly on the side of the face that has been affected. The condition is also known as oculosympathetic palsy or Horner-Bernard syndrome [1].

• Definition: Horner’s syndrome occurs when the nerve pathway that travels through brain to the face and then reaches the eye, gets damaged. This nerve pathway is disrupted only one side of the body. In this condition, a specific group of symptoms mark the onset of the syndrome.
• Cause: Horner’s syndrome mainly occurs due to underlying disease condition such as tumors, injury to the spinal cord or a stroke. In many cases, no cause can be identified and in such situations, the syndrome is termed as idiopathic Horner’s syndrome.
• Symptoms: Symptoms of Horner’s syndrome include decrease in the size of the pupil, delayed dilation of the pupil in dim light, and reduced sweating on one side of the face that is affected. In children with Horner’s syndrome, the color of the iris of the affected eye is different from the normal. In addition, the part of the face that is affected does not turn red after physical exertion or exposure to hot weather.
• Diagnosis: A preliminary medical examination of the signs and symptoms experienced by the individual forms basis of the diagnostic procedure. An eye examination is also carried out to evaluate the dilation of pupils in response to eye drops. Imaging studies such as chest X-ray, MRI of the brain and CT scan of the head would also be necessary.
• Treatment: Treatment of Horner’s syndrome largely depends on the underlying cause. If the causative factor can be treated then, the syndrome gets corrected by itself.

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3. Havelius UA. Horner-like syndrome and cluster headache. What comes first? Acta Ophthalmol Scand 2001; 79:374.
4. Woodruff G, Buncic JR, Morin JD.Horner's syndrome in children. J Pediatr Ophthalmol Strabismus 1988; 25:40.
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6. George ND, Gonzalez G, Hoyt CS. Does Horner's syndrome in infancy require investigation? Br J Ophthalmol 1998; 82:51.
7. Almog Y, Gepstein R, Kesler A. Diagnostic value of imaging in horner syndrome in adults. J Neuroophthalmol. Mar 2010;30(1):7-11.
8. Davies RP, Slavotinek JP, Dorney SF. VIP secreting tumours in infancy. A review of radiological appearances. Pediatr Radiol 1990; 20:504.
9. Watts P, Satterfield D, Lim MK. Adverse effects of apraclonidine used in the diagnosis of Horner syndrome in infants. J AAPOS. Jun 2007;11(3):282-3.
10. Selim M, Caplan LR. Carotid Artery Dissection.Curr Treat Options Cardiovasc Med 2004; 6:249.