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].

• 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: August 6, 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]

• Asymptomatic

  We describe a unique case of a rhabdomyosarcoma of the middle ear cavity in a four-year-old boy, presenting as an otherwise asymptomatic ipsilateral Horner's syndrome. [ncbi.nlm.nih.gov]

  Presentation May be asymptomatic. Symptoms [ 2 ] Inability to open eye fully on the affected side. Loss of sweating on the affected side. Facial flushing (if preganglionic lesion). Orbital pain/headache (if postganglionic lesion). [patient.info]

  Horner's syndrome secondary to asymptomatic pneumothorax in an adolescent. Eur J Pediatr 2007;166 (5) 507- 508 PubMed Google Scholar Crossref 3. Slavin ML Horner syndrome with equal-sized pupils in a case underlying physiologic anisocoria. [jamanetwork.com]

• Pallor

  On medical evaluation, she presented pallor, decreased capillary perfusion time, and diffuse abdominal pain. Complementary diagnostic tests revealed the presence of hemoperitoneum and severe anemia. [cureus.com]

• Vomiting

  […] face – pain and temperature CN 5 nucleus Ipsilateral Facial pain CN 5 nucleus Ipsilateral Ataxia – arm and leg Restiform body, cerebellum Ipsilateral Gait ataxia Restiform body, cerebellum Ipsilateral Nystagmus Vestibular nucleus Ipsilateral Nausea / vomiting [strokecenter.org]

  These may include: Vertigo (sensation that surroundings are spinning) with nausea and vomiting Double vision Lack of muscle control and coordination Arm pain, weakness and numbness One sided neck and ear pain Hoarseness Hearing loss Bladder and bowel [ufhealth.org]

• Nausea

  […] loss – face – pain and temperature CN 5 nucleus Ipsilateral Facial pain CN 5 nucleus Ipsilateral Ataxia – arm and leg Restiform body, cerebellum Ipsilateral Gait ataxia Restiform body, cerebellum Ipsilateral Nystagmus Vestibular nucleus Ipsilateral Nausea [strokecenter.org]

  These may include: Vertigo (sensation that surroundings are spinning) with nausea and vomiting Double vision Lack of muscle control and coordination Arm pain, weakness and numbness One sided neck and ear pain Hoarseness Hearing loss Bladder and bowel [ufhealth.org]

• Abdominal Pain

  On medical evaluation, she presented pallor, decreased capillary perfusion time, and diffuse abdominal pain. Complementary diagnostic tests revealed the presence of hemoperitoneum and severe anemia. [cureus.com]

• Vascular Disease

  Postganglionic lesions occur in between 0.5% and 57% of patients reported and arise from various pathologies including vascular disease and tumour. 4 The localisation of the lesion by clinical and pharmacological means is important and influences the [jnnp.bmj.com]

• 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]

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

  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. [symptoma.com]

• Anhidrosis

  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]

  The patient may also notice a loss of sweating on one side of the forehead or face, called anhidrosis. We therefore have a triad of ptosis, meiosis and anhidrosis. [eyes.gp-surgery.com]

  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]

  Last updated : April 27, 2022 Summary Horner syndrome (HS) is a neurological disorder characterized by a symptom triad of miosis (an abnormally small pupil), partial ptosis (drooping of the upper eyelid), and facial anhidrosis (absence of sweating). [amboss.com]

• 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]

  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 is characterized by a classic triad of ipsilateral pupillary miosis, partial eyelid ptosis, and facial anhydrosis. [ncbi.nlm.nih.gov]

• 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]

  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]

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

  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]

• Stroke

  […] the course of PCA stroke. [ahajournals.org]

  Most of the cases with a stroke had a lateral medullary infarction. Neoplastic causes Neoplastic causes included 4 pancoast tumors that affected the oculosympathetic pathway at the lung apex. [ophthalmologytimes.com]

  […] not in the course of PCA stroke. [stroke.ahajournals.org]

  Isolated Horner's syndrome may herald stroke. Cerebrovasc Dis. 2005;19(4):274-5 Glatt HJ, Putterman AM, Fett DR. Muller’s muscle-conjunctival resection procedure in the treatment of ptosis in Horner’s syndrome. Ophthalmic Surg 1990;21:93–6 [eyewiki.org]

• Dysarthria

  First-order neuron lesions  Hemisensory loss  Dysarthria  Dysphagia  Ataxia  Vertigo  Nystagmus 8. [slideshare.net]

  The symptoms reported by the patient will depend on the underlying cause, as follows: First-order neuron lesions – Hemisensory loss, dysarthria, dysphagia, ataxia, vertigo, and nystagmus Second-order neuron lesions – Prior trauma; facial, neck, axillary [emedicine.com]

• Neuralgia

  Herpes zoster is a common clinical problem but its complications, apart from post-herpetic neuralgia, are comparatively rare. [ncbi.nlm.nih.gov]

  Lyme disease associated with postganglionic Horner syndrome and Raeder paratrigeminal neuralgia. J Neuroophthalmol. 2007;27:123-124. 21. Bagheri N, Wajda BN, et al. [eyewiki.org]

  With the headache being migrainous in nature, similar to those experienced in the past, and in the presence of a normal ESR, it was thought initially that he had either cluster migraine or Raeder's paratrigeminal neuralgia with a postganglionic Horner's [nature.com]

  Lyme disease associated with postganglionic Horner's Syndrome and Raeder paratrigeminal neuralgia. J Neurophthalmol 2007; 27: 123–4. ↵ Lesser RL, Kornmehl EW, Pachner AR, et al. Neuro-opthalmologic manifestations of Lyme disease. [jabfm.org]

  Dermatologic vesicles and neuralgia can identify zoster as a cause. Cluster migraines also can cause Horner’s syndrome. Thus, a physical examination and history, often done in concert with an internist, help dictate management. [reviewofoptometry.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].

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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9. Watts P, Satterfield D, Lim MK. Adverse effects of apraclonidine used in the diagnosis of Horner syndrome in infants. J AAPOS. Jun 2007;11(3):282-3.
10. Selim M, Caplan LR. Carotid Artery Dissection.Curr Treat Options Cardiovasc Med 2004; 6:249.