Horner's Syndrome

Question 1

What is Horner’s syndrome?

Answer 1

It is defined as a condition in which there a lesion to the sympathetic chain supplying the eye

Question 2

What three eye structures are innervated by the sympathetic nerve system?

Answer 2

Dilator pupillae

Superior tarsal muscle

Sweat glands

Question 3

What is the function of the dilator papillae?

Answer 3

Pupil dilatation

Question 4

What is the function of the superior tarsal muscle?

Answer 4

Elevation of the upper eyelid

Question 5

What are the three classifications of Horner’s syndrome?

Answer 5

First Order Horner’s Syndrome

Second Order Horner’s Syndrome

Third Order Horner’s Syndrome

Question 6

Which clinical feature can be used to differentiate between the classifications?

Answer 6

Anhidrosis

Question 7

What is another term for first order Horner’s syndrome?

Answer 7

Central Horner’s syndrome

Question 8

What is first order Horner’s syndrome?

Answer 8

It involves a lesion to the first order neurone - which spans from the hypothalamus to the T1 spinal cord segment

Question 9

In first order Horner’s syndrome, which areas of the body are affected by anhidrosis?

Answer 9

Face

Arm

Trunk

Question 10

What are the four causes of first order Horner’s syndrome?

Answer 10

Stroke

Multiple Sclerosis

Brain Tumour

Encephalitis

Question 11

Which stroke syndrome is commonly associated with first order Horner’s syndrome?

Answer 11

Wallenberg’s syndrome

Question 12

What artery is affected in Wallenberg’s syndrome?

Answer 12

The posterior inferior cerebellar artery

Question 13

What are the five clinical features associated with Wallengerg’s syndrome?

Answer 13

Horner’s features

Ipsilateral ataxia

Dysphagia

Hoarseness

Reduced gag reflex

Question 14

What is another term for second order Horner’s syndrome?

Answer 14

Pre-ganglionic Horner’s syndrome

Question 15

What is second order Horner’s syndrome?

Answer 15

It involves a lesion to the second order neurone – which spans from the hypothalamus to the superior cervical ganglion, via the cervical sympathetic

Question 16

In second order Horner’s syndrome, which areas of the body are affected by anhidrosis?

Answer 16

Face

Question 17

What are the four causes associated with second order Horner’s syndrome?

Answer 17

Pancoast Tumour

Cervical Rib

Thyroid Malignancy

Brain Trauma

Question 18

What is another term for third order Horner’s syndrome?

Answer 18

Post-ganglionic Horner’s syndrome

Question 19

What is third order Horner’s syndrome?

Answer 19

It involves a lesion to the third order neurone – which spans from the superior cervical ganglion to the cavernous sinus, where the sympathetic fibres join the ophthalmic nerve (V1)

Question 20

In third order Horner’s syndrome, which areas of the body are affected by anhidrosis?

Answer 20

There is no anhidrosis

Question 21

What are the four causes of third order Horner’s syndrome?

Answer 21

Carotid Artery Dissection

Carotid Aneurysm

Cavernous Sinus Thrombosis

Cluster Headache

Question 22

Does Horner’s syndrome affect the contralateral or ipsilateral side in comparison to the lesion site?

Answer 22

Ipsilateral

Question 23

What are the four clinical features of Horner’s syndrome?

Answer 23

Miosis

Ptosis

Anhidrosis

Enophthalmos

Question 24

What is miosis?

Answer 24

It is defined as pupil constriction

Question 25

What is ptosis?

Answer 25

It is defined as eyelid drooping

Question 26

What is anhidrosis?

Answer 26

It is defined as lack of sweating

Question 27

What is enopthalmos?

Answer 27

It is defined as a sunken eye

Question 28

What is a clinical feature specific to congenital Horner's syndrome?

Answer 28

Iris heterochromia This is defined as a difference in iris colour

Question 29

What are the two investigations used to diagnose Horner's syndrome?

Answer 29

Alpha Adrenergic Agonist Eye Drops Amphetamine Eye Drops

Question 30

Name an alpha adrenergic agonist eye drop used to investigate Horner's syndrome

Answer 30

Apraclonidine

Question 31

How are apraclonidine eye drops used to investigate Horner's syndrome?

Answer 31

They are used to confirm a diagnosis

Question 32

What apraclonidine eye drop results indicate a diagnosis of Horner's syndrome? Explain this result

Answer 32

There is reversal of pupillary constriction - leading to pupil dilatation This is due to its agonistic effect on alpha-2 receptors

Question 33

Name an amphetamine eye drop used to investigate Horner's syndrome

Answer 33

Hydroxyamphetamine

Question 34

How are hydroxyamphetamine eye drops used to investigate Horner's syndrome?

Answer 34

They are used to locate the lesion in Horner’s syndrome

Question 35

What hydroxyamphetamine eye drop results indicate a diagnosis of preganglionic (1st, 2nd order neurone) Horner's syndrome?

Answer 35

Pupil dilatation

Question 36

What hydroxyamphetamine eye drop results indicate a diagnosis of postganglionic (3rd order neurone) Horner's syndrome?

Answer 36

No pupil dilatation

Question 37

How do we manage Horner's syndrome?

Answer 37

We treat the underlying cause