Horner's Syndrome

Question 1

Define Horner’s syndrome

Answer 1

A syndrome arising due to the interruption of the face’s sympathetic supply. A triad of Ipsilateral:
• Miosis: Pupillary constriction
• Partial Ptosis (drooping eyelid) and apparent enophthalmos (sunken eye).
• Anhidrosis (lack of sweat).

Question 2

What are the causes/risk factors of Horner’s syndrome?

Answer 2

Central - anhidrosis of face, arm and trunk 
• Syringomyelia 
• Multiple sclerosis 
• Encephalitis 
• Brain tumors 
• Lateral medullary syndrome 

Preganglionic - anhidrosis of face
• Cervical Ribs (Traction on stellate ganglion)
• Thyroid carcinoma
• Thyroidectomy
• Thyroid Goitre
• Pancoast tumor
• Klumpke paralysis –C8 & T1 –commonly during childbirth
• Trauma: Base of neck, usually blunt trauma, sometimes surgery.
• Thoracic aortic aneurysm

Postganglionic - no anhidrosis
• Cluster headache: combination termed Horton’s headache
• Carotid artery dissection/carotid artery aneurysm
• Cavernous sinus thrombosis
• Middle ear infection

Other causes:
• sympathectomy
• nerve blocks e.g. plexus block, stellate ganglion or interscalene block

Question 3

What are the symptoms of Horner’s syndrome?

Answer 3

• Inability to open the eye fully on the affected side
• Loss of sweating on affected side
• Facial flushing
• Orbital pain/headache
• Other symptoms based on cause

Question 4

What are the signs of Horner’s syndrome?

Answer 4

• ptosis
• miosis
• anhydrosis
• enopthalmos

Question 5

What investigations are carried out for Horner’s syndrome?

Answer 5

to find underlying cause

• CXR - spical lung tumour
• CT/MRI - cerebrovascular accident
• CT angiography - dissection

Question 6

What is the management for Horner’s syndrome?

Answer 6

based on cause