Horner's Syndrome Flashcards
What is Horner’s syndrome?
It is defined as a condition in which there a lesion to the sympathetic chain supplying the eye
What three eye structures are innervated by the sympathetic nerve system?
Dilator pupillae
Superior tarsal muscle
Sweat glands
What is the function of the dilator papillae?
Pupil dilatation
What is the function of the superior tarsal muscle?
Elevation of the upper eyelid
What are the three classifications of Horner’s syndrome?
First Order Horner’s Syndrome
Second Order Horner’s Syndrome
Third Order Horner’s Syndrome
Which clinical feature can be used to differentiate between the classifications?
Anhidrosis
What is another term for first order Horner’s syndrome?
Central Horner’s syndrome
What is first order Horner’s syndrome?
It involves a lesion to the first order neurone - which spans from the hypothalamus to the T1 spinal cord segment
In first order Horner’s syndrome, which areas of the body are affected by anhidrosis?
Face
Arm
Trunk
What are the four causes of first order Horner’s syndrome?
Stroke
Multiple Sclerosis
Brain Tumour
Encephalitis
Which stroke syndrome is commonly associated with first order Horner’s syndrome?
Wallenberg’s syndrome
What artery is affected in Wallenberg’s syndrome?
The posterior inferior cerebellar artery
What are the five clinical features associated with Wallengerg’s syndrome?
Horner’s features
Ipsilateral ataxia
Dysphagia
Hoarseness
Reduced gag reflex
What is another term for second order Horner’s syndrome?
Pre-ganglionic Horner’s syndrome
What is second order Horner’s syndrome?
It involves a lesion to the second order neurone – which spans from the hypothalamus to the superior cervical ganglion, via the cervical sympathetic
In second order Horner’s syndrome, which areas of the body are affected by anhidrosis?
Face
What are the four causes associated with second order Horner’s syndrome?
Pancoast Tumour
Cervical Rib
Thyroid Malignancy
Brain Trauma
What is another term for third order Horner’s syndrome?
Post-ganglionic Horner’s syndrome
What is third order Horner’s syndrome?
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)
In third order Horner’s syndrome, which areas of the body are affected by anhidrosis?
There is no anhidrosis
What are the four causes of third order Horner’s syndrome?
Carotid Artery Dissection
Carotid Aneurysm
Cavernous Sinus Thrombosis
Cluster Headache
Does Horner’s syndrome affect the contralateral or ipsilateral side in comparison to the lesion site?
Ipsilateral
What are the four clinical features of Horner’s syndrome?
Miosis
Ptosis
Anhidrosis
Enophthalmos
What is miosis?
It is defined as pupil constriction
What is ptosis?
It is defined as eyelid drooping
What is anhidrosis?
It is defined as lack of sweating
What is enopthalmos?
It is defined as a sunken eye
What is a clinical feature specific to congenital Horner’s syndrome?
Iris heterochromia
This is defined as a difference in iris colour
What are the two investigations used to diagnose Horner’s syndrome?
Alpha Adrenergic Agonist Eye Drops
Amphetamine Eye Drops
Name an alpha adrenergic agonist eye drop used to investigate Horner’s syndrome
Apraclonidine
How are apraclonidine eye drops used to investigate Horner’s syndrome?
They are used to confirm a diagnosis
What apraclonidine eye drop results indicate a diagnosis of Horner’s syndrome? Explain this result
There is reversal of pupillary constriction - leading to pupil dilatation
This is due to its agonistic effect on alpha-2 receptors
Name an amphetamine eye drop used to investigate Horner’s syndrome
Hydroxyamphetamine
How are hydroxyamphetamine eye drops used to investigate Horner’s syndrome?
They are used to locate the lesion in Horner’s syndrome
What hydroxyamphetamine eye drop results indicate a diagnosis of preganglionic (1st, 2nd order neurone) Horner’s syndrome?
Pupil dilatation
What hydroxyamphetamine eye drop results indicate a diagnosis of postganglionic (3rd order neurone) Horner’s syndrome?
No pupil dilatation
How do we manage Horner’s syndrome?
We treat the underlying cause
