Horner's Syndrome

Question 1

What is the definition of Horner’s

Answer 1

a condition that results from the disruption of the sympathetic nerves supplying the face resulting in a triad of Ptosis, Miosis and Anhydrosis (+ enophthalmos)

Question 2

Describe the aetiology / risk factors involved with Horner’s

Answer 2

It is caused by disruption of the sympathetic nerves which can be due to the following:

• Strokes
• Multiple sclerosis
• Apical lung tumours
• Lymphadenopathy
• Basal skull tumours
• Carotid artery dissection
• Neck trauma

Question 3

What is the epidemiology of Horner’s

Answer 3

Although it is usually rare it is an important sign that is associated with various diseases (most notably pancoast tumours

Question 4

What are the presenting symptoms of Horners

Answer 4

• 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 5

What are the signs present on examination of a patient with Horner’s

Answer 5

Ptosis

Miosis

Anhydrosis

Enophthalmos

Question 6

What are the appropriate investigations when Horner’s is suspected?

Answer 6

Investigations are directed towards figuring out the underlying cause

• CXR - apical lung tumour
• CT/MRI - cerebrovascular accidents
• CT angiography - dissection

Question 7

How is Horner’s syndrome managed?

Answer 7

Horner’s syndrome is a sign not a disease in itself

So, the management depends on the cause (e.g. management for carotid dissection is very different to management of apical lung tumours)

Question 8

What determines the potential complications and prognosis of patients with horners?

Answer 8

It is dependent on the cause of the syndrome