Horner’s syndrome affects one side of the face. The following are the signs and symptoms experienced by individuals suffering from this syndrome:

• Onset of miosis, a condition wherein there is decrease in the size of the pupil.
• Anisocoria, wherein there is considerable difference between both pupils.
• Delayed dilation of pupil in dim light.
• Onset of upside down ptosis, a condition characterized by elevation of lower eye lid.
• Dropping eye lids, especially the upper one.
• Affected side experiences little or no sweating.
• Children affected by Horner’s syndrome, do not experience the flushing or redness of face in the affected side as one would normally experience after exposure to heat or after physical exertion. In addition, the color of the iris in affected children is lighter than the normal eye [6].

• Pain

  Horner's syndrome associated with pain always needs investigation. If there is arm, shoulder or hand pain think of Pancoast's syndrome. If pain is in the face or neck, think of carotid dissection. [patient.info]

  Dissociated sensory loss: lost pain and temperature sensation, but preserved light touch, vibration and proprioception Cape-like distribution of pain Hand weakness Bowel and bladder incontinence, sexual dysfunction Spinal injury or infarction Weakness [derangedphysiology.com]

  Pain persisted after finishing the swimming leg, and was associated with right-sided ptosis and blurred vision; the patient went to hospital 24hours later. [elsevier.es]

• Swelling

  There was non-tender swelling of the entire right arm present (figure 2). Supplementary video [emermed-2021-211257supp001.MOV] Figure 1 Examination revealed right-sided Horner syndrome, with right-sided partial blepharoptosis and pupillary miosis. [emj.bmj.com]

  Definition Horner's syndrome is a eye disorder that consists of enophthalmos (sinking of the eyeball into its cavity), ptosis (droopy upper eyelid), swelling of the lower eyelid, miosis (abnormal contraction of the pupil), anhidrosis (absence of facial [healthcentral.com]

  Unless the airway is blocked or the brain is swelling, waiting to start treatment usually isn't a problem. [urmc.rochester.edu]

  This causes more pressure in the veins and face, which leads to a buildup of fluid or swelling. [cancer.ca]

• Surgical Procedure

  procedures in this region including radical neck dissection, jugular vein cannulation, thoracoscopy or mediastinoscopy, chest tube placement and other thoracic surgical procedures. [eyewiki.org]

  Potentially life-threatening causes of congenital Horner's, including thoracic and cervical neuroblastoma, agenesis of the internal carotid artery and complications from perinatal surgical procedures have also been reported. [webeye.ophth.uiowa.edu]

• Fatigue

  The labor and delivery were uncomplicated except for maternal fatigue and insufficient pushing, resulting in vacuum-assisted vaginal delivery. The patient's medical [jamanetwork.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  The patient reports that her cough has not resolved and feels fatigued. Medical history is significant for hypertension and hyperlipidemia, which is currently being treated with hydrochlorothiazide and atorvastatin. [step1.medbullets.com]

• Falling

  The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. [ncbi.nlm.nih.gov]

  Subject Anisocoria; Blepharoptosis; Carotid Artery Diseases; Carotid Artery Injuries; Chile; Horner Syndrome; Humans; Magnetic Resonance Imaging; Male; Miosis; Palate, Soft Abstract A 7-year-old boy developed a Horner's syndrome after falling on a stick [collections.lib.utah.edu]

  CASE A 22-year-old man was brought to the emergency room after motorcycle fall, with history of transitory loss of conscience. [scielo.br]

  The potential causes are numerous and fall into 3 categories: Central lesions (expect anhydrosis of the upper forequarter and coexistent neurological deficits) Preganglionic lesions Postganglionic lesions (may not affect sweating — main sympathetic outflow [lifeinthefastlane.com]

• Pharyngitis

  […] nerve lesions Cavernous sinus pathology An associated sixth nerve palsy Everything in the cavernous sinus may have been taken out (that being upper facial branches of the 5th nerve, the 4th nerve and the 3rd nerve) Syringobulbia Dysphagia Nystagmus Pharyngeal [derangedphysiology.com]

  Magnetic resonance imaging showed an expansive submucosal lesion of the nasopharynx involving the para-pharyngeal space, tensor and levator veli palati muscles and the apex of petrous bone. Positron emission tomography excluded distant metastasis. [ncbi.nlm.nih.gov]

• Pleural Effusion

  RESULTS: Present radiographic methods revealed one-sided metastatic pleural effusion as a cause of sympathetic lesion. [ncbi.nlm.nih.gov]

• Arthralgia

  Lyme disease in North America, where it is a known cause of acute and delayed musculoskeletal and neurologic disease (Figure 4).3 Approximately 68% of patients with early Lyme disease present with systemic viral-like symptoms, most commonly fatigue, arthralgia [jabfm.org]

• Sweating

  Hemifacial anhidrosis (absence of sweating). [patient.info]

  […] glands Horner’s syndrome is characterised by the triad of ptosis (drooping eyelid), anhidrosis (lack of sweating) and miosis (constricted pupil) on the ipsilateral side (Figure 1).1 Figure 1. [geekymedics.com]

  Sweating is not usually affected by postganglionic horners lesions due to divison of the nerve supply at the carotid bifurcation. [eyes.gp-surgery.com]

• Anhidrosis

  A useful way to differentiate the location of the lesion is to assess the sites affected by anhidrosis: Anhidrosis of face, arm and trunk: central/first order Anhidrosis of face: second-order No anhidrosis: third-order First-order (central Horner’s) The [geekymedics.com]

  Other signs Anhidrosis: Variable degree of loss of sweating can be seen depending on the site of the lesion. Central or preganglionic lesions tend to produce more noticeable anhidrosis. [eyewiki.aao.org]

  Central or preganglionic lesions tend to produce more noticeable anhidrosis. The sudomotor and vasomotor fibers to most of the face separate out at the superior cervical ganglion and anhidrosis is often not noticeable in postganglionic lesions. [eyewiki.org]

  He presented changes in facial skin colouration after exercise: the left side of his face was flushed and sweaty, whereas the right side was pale, showing anhidrosis. [elsevier.es]

• Flushing

  The phrase “Harlequin syndrome” refers to patients presenting with hemifacial flushing and sweating in the absence of other neurological symptoms, whereas “Harlequin sign” is used to describe flushing and sweating associated with other autonomic signs [thejns.org]

  Children with isolated Horner's syndrome may present when parents notice a difference in eye color or impaired facial flushing. [eyewiki.org]

  Children with isolated Horner's syndrome may present when parents notice a difference in eye color, pupil size, or impaired facial flushing. [eyewiki.aao.org]

  This case study reports a 7-year-old boy with right miosis, mild blepharoptosis, and iris hypopigmentation detected in a routine pediatric follow-up without ipsilateral facial anhydrosis, flushing, or pain. [ncbi.nlm.nih.gov]

• Decreased Sweating

  From Wikidata Jump to navigation Jump to search Human disease characterized by miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhydrosis (decreased sweating), with apparent enophthalmos (inset eyeball) Bernard Horner syndrome [wikidata.org]

  The signs of the syndrome occur on the same side as the lesion of the sympathetic trunk and include: a constricted pupil, a weak-droopy eyelid, apparent decreased sweating, and with or without inset eyeball. [ncbi.nlm.nih.gov]

  Decreased sweating on the affected side of the face, Drooping eyelid (ptosis), Sinking of the eyeball into the face, Small (constricted) pupil (the black part in the center of the eye) Treatment depends on the cause of the problem. [omicsonline.org]

• Miosis

  Case 2 showing miosis prior to apraclonodine hydrochloride, 0.5%, testing. Figure 6. Case 2 showing reversal of miosis 30 minutes after administration of apraclonodine hydrochloride, 0.5%. [jamanetwork.com]

  Left-sided Horner’s syndrome with ipsilateral ptosis and miosis.3 Horner’s can arise an isolated injury or as a manifestation of a systemic disease process.2 This article will cover the classification and causes of Horner’s syndrome. [geekymedics.com]

  Horner syndrome classically manifests as ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis [ 1, 2 ]. [doi.org]

  Clinical diagnosis Horner’s syndrome is diagnosed clinically by observing ptosis (of upper and lower lids), miosis of the ptotic eye and demonstration of dilation lag in the affected eye. [eyewiki.org]

  Horner’s syndrome (also called oculosympathetic paresis, or Horner syndrome) comprises a constellation of clinical signs including the classic triad of ptosis, miosis, and anhidrosis. [eyewiki.aao.org]

• Enophthalmos

  Unfortunately, the authors perpetuate the extremely common misconception that enophthalmos accompanies ptosis and miosis in human Horner Syndrome. It is only an illusion of enophthalmos caused by the ptosis. [doi.org]

  From Wikidata Jump to navigation Jump to search Human disease characterized by miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhydrosis (decreased sweating), with apparent enophthalmos (inset eyeball) Bernard Horner syndrome [wikidata.org]

  Horner (1831 to 1886), Swiss anatomist Synonyms: Horner's trias, Horner's complex, Horner's symptom complex, oculopupillary syndrome German : Horner-Syndrom 1 Definition The Horner's syndrome is a combination of symptoms consisting of miosis, ptosis and enophthalmos [flexikon.doccheck.com]

• Blepharoptosis

  Supplementary video [emermed-2021-211257supp001.MOV] Figure 1 Examination revealed right-sided Horner syndrome, with right-sided partial blepharoptosis and pupillary miosis. [emj.bmj.com]

  This case study reports a 7-year-old boy with right miosis, mild blepharoptosis, and iris hypopigmentation detected in a routine pediatric follow-up without ipsilateral facial anhydrosis, flushing, or pain. [ncbi.nlm.nih.gov]

  Subject Anisocoria; Blepharoptosis; Carotid Artery Diseases; Carotid Artery Injuries; Chile; Horner Syndrome; Humans; Magnetic Resonance Imaging; Male; Miosis; Palate, Soft Abstract A 7-year-old boy developed a Horner's syndrome after falling on a stick [collections.lib.utah.edu]

  Horner syndrome classically presents as an ipsilateral enophthalmos, blepharoptosis, pupillary miosis and facial anhydrosis due to disruption at some point of the oculosympathetic pathway. [radiopaedia.org]

• Unilateral Ptosis

  A 17-year-old girl was admitted with a 1-year history of right-sided headaches and unilateral ptosis for 6 months. She was diagnosed with Horner's syndrome. [ncbi.nlm.nih.gov]

  Reference #2: Unilateral ptosis and miosis caused by pneumomediastinum Chipman et al. [journal.chestnet.org]

  Ptosis secondary to a Horner's syndrome can usually be distinguished from isolated congenital ptosis because of the associated ocular and adnexal findings. Infants present with unilateral ptosis but also with associated miosis. [webeye.ophth.uiowa.edu]

  Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis,. Download full- text PDF. Buckley SJ, Horner V, Wing T, Bird G. SINDROM HORNER Oleh: dr. [cirykoxuti.ga]

• Pupillary Abnormality

  Pupillary abnormalities ; Atlas of Ophthalmology Crippa SV, Borruat FX, Kawasaki A ; Pupillary dilation lag is intermittently present in patients with a stable oculosympathetic defect (Horner syndrome). Am J Ophthalmol. 2007 Apr143(4):712-5. [patient.info]

  Finally, an abnormality of the third cranial nerve (a nerve that comes from the brain to the eye socket and controls eyelid position, eye movement, and pupil size) can cause a pupillary abnormality. [aapos.org]

• Suggestibility

  Some authorities suggest MRI and MRA of the head, neck, and pulmonary apex using predefined Horner protocols. [healio.com]

  There was no history of birth trauma and test with cocaine provoked no response of the right pupil, suggesting right Horner's syndrome. [ncbi.nlm.nih.gov]

  Horner syndrome accompanied by third, fifth, or sixth cranial nerve palsy suggests the presence of a lesion in the cavernous sinus, superior orbital fissure, or orbital apex. [doi.org]

  If the pupil fails to dilate, this suggests that the lesion is in the third order or postganglionic neuron.2 Management Like investigations, the management of Horner’s depends on the underlying cause. [geekymedics.com]

• Paresis

  Although Horner's syndrome has been reported with several disorders of the carotid artery, our case documents a rare iatrogenic oculosympathetic paresis after elective carotid endarterectomy. [ncbi.nlm.nih.gov]

• Irritability

  799.22 sympathetic (nervous system) (see also Neuropathy, peripheral, autonomic) 337.9 Irritation peripheral sympathetic nerve NEC (see also Neuropathy, peripheral, autonomic) 337.9 Neuropathy, neuropathic (see also Disorder, nerve) 355.9 Paralysis, [icd9data.com]

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

  Therefore, we suspected a probable irritating and/or compressive effect due to the drain, which was instantly removed. FIG. 2. [thejns.org]

• Neurologic Manifestation

  Erythema migrans is the most common manifestation of Lyme disease, and is usually seen 7-14 days after the tick bite. Patients seldom remember the tick bite. Patients may often present with neurological manifestations indicating neuroborreliosis. [ncbi.nlm.nih.gov]

  Thus, the physician who diagnoses a possible Horner syndrome must carefully assess the patient for other neurologic manifestations that may help confirm the diagnosis and be helpful in localizing the site of injury. [dovepress.com]

A general medical examination would be carried out in the preliminary stages, followed by other tests to identify the nature of the symptoms and exact cause behind development of Horner’s syndrome. Typically the following tests would be done:

• Eye examination: In this test, eye drops will be administered to both eyes; the pupil of the healthy eye will get dilated, whereas the eye drops will constrict the pupil of the affected eye. This will help in confirming the diagnosis of Horner’s syndrome.
• Imaging studies: Imaging studies such as CT scan, MRI and X-ray will be done in order to locate the site of nerve damage. A chest radiograph would provide insight about the development of apical bronchogenic carcinoma which is considered as one of the most potential causes of Horner’s syndrome. In addition, MRI of the brain and CT scan of the head are also indicated [7].
• Blood and urine tests would also form an important part of the diagnostic procedure and are done if children are suspected to be suffering from Horner’s syndrome. These tests are necessary to diagnose the presence of neuroblastoma [8].
• Pharmacologic testing: This method is very helpful in diagnosis of Horner’s syndrome. These include the topical cocaine test, topical apraclonidine test and topical hydroxyamphetamine test [9].

• Pleural Effusion

  RESULTS: Present radiographic methods revealed one-sided metastatic pleural effusion as a cause of sympathetic lesion. [ncbi.nlm.nih.gov]

There is no specific treatment regime for Horner’s syndrome. The major goal of treatment is to successfully treat the underlying disease condition, which would in turn help in appropriate management of the condition.

Surgical intervention may also be required when the carotid artery is involved. The types of surgical procedures indicated in treatment of Horner’s syndrome include neurosurgical procedures, and vascular surgical methods for aneurysm or dissection of the carotid artery [10].

The prognosis of the condition majorly depends on the underlying causative factor. If the underlying causative factor can be successfully treated, then the prognosis of Horner’s syndrome is usually favorable.

Horner’s syndrome occurs when certain groups of nerves of the sympathetic trunk are damaged. The sympathetic nerves are responsible for regulation of the heart rate, blood pressure, perspiration and size of the pupil. Injury or damage to the nerve fibers can stem from the following factors [2]:

• Injury to the carotid artery
• Individuals suffering from migraine [3]
• Development of tumor in the lungs
• Development of tumor in the brainstem
• Stroke
• Sympathectomy, wherein surgery is done to relieve pain by interrupting the nerve fibers
• Injury to the nerves of the brachial plexus
• In many instances, the cause of Horner’s syndrome is unknown and cannot be identified. Such a type of condition is then termed as idiopathic Horner’s syndrome.

Horner’s syndrome is a rare disorder affecting about 1 in 6250 newborns. The condition can also occur later in life; but the exact incidence in such cases is unknown [4].

Horner’s syndrome develops as a result of a lesion which occurs at any point in the pathway of the sympathetic trunk. Due to such a kind of phenomenon, all patients experience abnormalities such as ptosis, elevation of the lower eye lid, development of dilation lag and miosis and impaired flushing and sweating. The degree of severity of these abnormalities depends on the extent of damage to the nerve fibers.

Anatomically, 3 groups of nerves responsible for the sympathetic function of the eye are the first order, second order and third order neurons. The first order neurons travel from the hypothalamus to the cervical spine. The second order neurons travel from neck to the outer side of the spinal region. Lastly, the third order neurons, travel through the outer side of the spinal cord to the eye [5].

Prevention of Horner’s syndrome is geared towards preventing the onset of trigger factors. This would include prevention of trauma of the head, avoiding smoking and controlling various cardiovascular risk factors. All these approaches can help prevent the onset of Horner’s syndrome.

Horner’s syndrome is characterized by development of various kinds of signs and symptoms that occur as result of damage to the sympathetic trunk. Such a type of condition affects the face and eyes. This syndrome produces signs and symptoms that affect one side of the body where there is lesion of the sympathetic trunk. Horner’s syndrome causes decrease in the size of the pupil, drooping eyelid and reduced sweating particularly on the side of the face that has been affected. The condition is also known as oculosympathetic palsy or Horner-Bernard syndrome [1].

• Definition: Horner’s syndrome occurs when the nerve pathway that travels through brain to the face and then reaches the eye, gets damaged. This nerve pathway is disrupted only one side of the body. In this condition, a specific group of symptoms mark the onset of the syndrome.
• Cause: Horner’s syndrome mainly occurs due to underlying disease condition such as tumors, injury to the spinal cord or a stroke. In many cases, no cause can be identified and in such situations, the syndrome is termed as idiopathic Horner’s syndrome.
• Symptoms: Symptoms of Horner’s syndrome include decrease in the size of the pupil, delayed dilation of the pupil in dim light, and reduced sweating on one side of the face that is affected. In children with Horner’s syndrome, the color of the iris of the affected eye is different from the normal. In addition, the part of the face that is affected does not turn red after physical exertion or exposure to hot weather.
• Diagnosis: A preliminary medical examination of the signs and symptoms experienced by the individual forms basis of the diagnostic procedure. An eye examination is also carried out to evaluate the dilation of pupils in response to eye drops. Imaging studies such as chest X-ray, MRI of the brain and CT scan of the head would also be necessary.
• Treatment: Treatment of Horner’s syndrome largely depends on the underlying cause. If the causative factor can be treated then, the syndrome gets corrected by itself.

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10. Selim M, Caplan LR. Carotid Artery Dissection.Curr Treat Options Cardiovasc Med 2004; 6:249.