Horner's Syndrome

Question 1

Definition

Answer 1

A condition that results from the disruption of the sympathetic nerves supplying the
face resulting in a triad of:

o Ptosis (drooping upper eyelid)
o Miosis (pupil constriction)
o Anhydrosis (unable to perspirate)
o (and enophthalmos)

Question 2

Aetiology

Answer 2

• It is caused by disruption of the sympathetic nerves

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

Question 3

Epidemiology

Answer 3

• RARE

* Important sign that is associated with various diseases (most notably, Pancoast tumours-tumour of the pulmonary apex))

Question 4

Presenting symptoms

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

Signs on physical examination

Answer 5

• Ptosis
• Miosis
• Anhydrosis
• Enophthalmos

Question 6

Investigations

Answer 6

• Investigations are directed towards figuring out the underlying cause
• CXR - apical lung tumour
• CT/MRI - cerebrovascular accidents
• CT angiography - dissection

Question 7

Management plan

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

Possible complications

Answer 8

Depends on the cause

Question 9

Prognosis

Answer 9

Depends on the cause