Horner's Syndrome

Question 1

Define Horner’s Syndrome

Answer 1

Triad of ptosis (dropping upper eyelid), miosis (constricted pupil) and anhidrosis (ipsilateral loss of sweating)

Question 2

Aetiology of Horner’s Syndrome

Answer 2

Interruption of the face’s sympathetic supply
Cause depends on location of interruption:

Brainstem: demyelination, vascular disease (stroke), encephalitis
Cord: syringomyelia, multiple sclerosis, tumour
Thoracic outlet: Pancoast’s tumour, thyroidectomy, cervical rib, trauma
Post-ganglionic: carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, cluster headache (no anhidrosis)
Where the sympathetic nerve travels with the internal carotid artery into the skull

Question 3

Symptoms of Horner’s Syndrome

Answer 3

Headache
Oncological aetiology (tumour): Cough, haemoptysis, neck swelling

Question 4

Signs of Horner’s Syndrome on examination

Answer 4

Ptosis
Miosis
Anhidrosis
May have enophthalmos (sunken eyes)
Congenital/neuroblastoma

Question 5

Investigations for Horner’s Syndrome

Answer 5

Topical cocaine eyedrops: minimal to no improvement of miosis

Hydroxyamphetanine/tropicamide ophathalmic test: minimal to complete resolution of miosis

CT chest: mass lesion in lung apex, previous chest surgery AAA,
MRI brain/neck: Brainstem or upper cervical chest spinal cord lesions |cervical disc disease | changes to internal carotid artery or cavernous sinus
Carotid angiograph: aneurysm of the internal carotid or posterior communicating

Question 6

Management for Horner’s Syndrome

Answer 6

Treat underlying cause