What Is The Best Treatment for Horner’s Syndrome?

Horner syndrome is the collection of symptoms occurring due to damage to the nerve fibers of the sympathetic nervous system supplying to the eye and surrounding regions. Since the nervous tissue is a stable tissue and does not undergo regeneration once it has differentiated and matured completely. Because of which if there is damage to the nerve fibers it would be permanent and cannot be regenerated or regressed to the normal condition. Following the same mode of differentiation, sympathetic fibers are also a type of nerve fibers that get affected in the horner syndrome and if they are compressed or damaged for a longer period of time then there is no scope for treatment in it. Despite the widespread research to date and even ongoing, there has not been any specific medication or surgical treatment developed to regenerate the nerve fibers and make connections between them to work functionally and efficiently.

What Is The Best Treatment for Horner’s Syndrome?

The best and the most efficient mode of treatment in horner’s syndrome is to actively treat the underlying etiology of it before it reaches the state of permanent damage from which it cannot be reversed. The causes of horner’s syndrome can be congenital or acquired and range from benign vascular headache to intracranial malignant tumors.

There is treatment possible for underlying causes like a cerebrovascular accident by the use of thrombolytic agents, demyelinating diseases can also be treated medically with drugs like fingolimod, glatiramer, Natalizumab, etc., mandibular abscess or acute otitis media can be treated by the use of antibiotics. Central venous line placement and chest tube placement should be carefully done to prevent the trauma to the sympathetic chain which can result in horner syndrome.(1) Basal meningitis is also one of the causes which are treatable by medications. Antihypertensive medications can be started timely to prevent aortic aneurysm, internal carotid artery dissection which can also late to horner’s syndrome sometimes in few cases.

Surgical treatment has more application in horner syndrome because many of the causes are surgically treatable. Removal of the cervical rib, excision of the thoracic tumors like neuroblastoma, Pancoast tumor, lymphadenectomy, etc can be performed timely to prevent horner syndrome from occurring. Removal of pituitary tumors, relieving of compression caused by syringomyelia, the release of pressure due to intrapontine hemorrhage, are some of the surgical treatment modalities that can be applied in the treatment of horner’s syndrome. Radiofrequency ablation and laser treatment are done for any of the head and neck surgeries or dissection should be carefully done to prevent the damage to the sympathetic system.

Sometimes, the causes are not easily treatable or there is a delay in the diagnosis due to a variety of reasons including patient or doctor negligence. Also, there can be the slow treatment of the underlying cause before with the sympathetic nervous fibers gets destroyed permanently and even after the regression of the disease, it is not effective in treating horner’s syndrome. These all causes lead to poor prognosis and a low success rate of treatment in horner’s syndrome.(2)

Conclusion

Horner syndrome is a medical condition that is characterized by a triad of symptoms occurring due to some underlying etiology usually. It is very rare that horner syndrome sometime may not have any etiology and has idiopathic causation. Specific treatment for the symptoms of horner’s syndrome is not available to date because of the fact that there is damage to the nerve fibers which is permanent in nature and cannot be regenerated to the complete extent whether medically or surgically.(3) So, once the horner’s syndrome has happened and damage becomes permanent there is no complete regression of the disease and an effective cure is not available. The prognosis of the patient becomes poor and quality of life is also affected because of it. Time also becomes very important because of the specialty of nerve fibers to endure the compression for a shorter period of time.

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