Horner's Syndrome

Question 1

Define Horner’s Syndrome?

Answer 1

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

• Ptosis
• Miosis
• Anhydrosis
• (and enophthalmos)

Question 2

What is the aetiology of Horner’s Syndrome?

Answer 2

It is caused by disruption of the sympathetic nerves

Question 3

What are the causes of Horner’s Syndrome?

Answer 3

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

Question 4

What is the epidemiology of Horner’s Syndrome?

Answer 4

RARE

Important sign that is associated with various diseases (most notably, Pancoast tumours)

Question 5

What are the presenting symptoms of Horner’s Syndrome?

Answer 5

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 6

What are the signs of Horner’s Syndrome?

Answer 6

Ptosis
Miosis
Anhydrosis
Enophthalmos

Question 7

What investigations do you do for Horner’s Syndrome?

Answer 7

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

Question 8

What is the management plan for Horner’s Syndrome?

Answer 8

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 apial lung tumours)