Horner's syndrome

Question 1

what are the features of Horner’s syndrome?

Answer 1

• miosis (small pupil)
• ptosis
• enophthalmos* (sunken eye)
• anhidrosis (loss of sweating one side)

^{*in reality the appearance is due to a narrow palpebral aperture rather than true enophthalmos}

Question 2

how do you distinguish between causes of Horner’s syndrome?

Answer 2

• heterochromia (difference in iris colour) is seen in congenital Horner’s
• anhidrosis: see below

Question 3

anhidrosis in head, arm and trunk.

where is the lesion?

Answer 3

central lesion ⇒ stroke, syringomyelia

Question 4

anhidrosis in just the face.

where is the lesion?

Answer 4

pre-ganglionic lesion ⇒ Pancoast’s, cervical rib

Question 5

anhidrosis absent.

where is the lesion?

Answer 5

post-ganglionic lesion ⇒ carotid artery

Question 6

A 48-year-old man presents with a ‘droopy eyelid’ on the right side. You also notice that his right pupil appears smaller than the left.

What is this most likely to represent?

Answer 6

A right-sided ptosis and miosis can be seen pointing to a diagnosis of Horner’s syndrome.