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Can MS Cause Horner’s Syndrome & Can Botox Cause It?

Horner’s syndrome causes specific nerve damages that relate to various eye muscles. The disease consists of a three-part symptom complex (symptom triad) including a drooping upper eyelid, a significant pupil narrowing, and a sunken eye socket.(1)

Can MS Cause Horner's Syndrome?

Can MS Cause Horner’s Syndrome?

MS or multiple sclerosis can cause Horner’s syndrome. Multiple sclerosis affects the CNS or central nervous system by demyelination. Careful physical examination and going through patient history may assist in guiding imaging studies to help locate the injury or lesion location. In fact, Horner’s syndrome is a sign revealing that the brain stem was affected by multiple sclerosis. In Horner’s syndrome, pupils are narrow and there are no weaknesses in the gaze.(2)(3)

Can Botox Cause Horner’s Syndrome?

Botox is used medically to treat some muscle diseases. It also has cosmetic use in removing wrinkles through muscle paralysis. It is made from a neurotoxin called botulinum toxin produced by Clostridium botulinum, a specific bacterium.

A major botulinum toxin injection complication is drooping from the upper eyelid. Eyelid drooping may also evident in Horner syndrome and can be successfully treated with apraclonidine hydrochloride. No cases of eyelid drooping caused by botulinum toxin injection have been reported in the literature. But, the botox will not promote Horner’s syndrome and it only can cause eyelid drooping similar to Horner’s syndrome.(4)

Other Causes Of The Disease

The hypothalamus (an important area in the human brain) is responsible for controlling the eye muscles, which can lead to the symptoms typical of Horner syndrome. To transmit information from the hypothalamus to the eye and vice versa, the nerve pathways have to go through a complicated cycle involving the spinal cord.

During this route, the cranial nerves can be damaged at any time. Often there is damage to the nerve pathways due to circulatory disorders (this is usually located in the brain stem) or a brain tumor that affects the nerves in question and can damage them. Cancerous ulcers on the top of the lungs and pathological cavities in the cervical spine can also lead to nerve damage and thus trigger Horner’s syndrome.

Inflammation, localized in the middle cranial fossa, can also lead to the symptom triad of Horner’s syndrome.(3)

Diagnosis Of Horner’s Syndrome

The three-part symptom complex is easy to recognize. In patients with Horner’s syndrome, the damaged pupil is relatively smaller than the intact pupil, the eyelid hangs down and can only be raised minimally even under exertion.

In response to light, the pupil in Horner’s syndrome dilates slowly and mostly incompletely. The other symptoms are also clearly recognizable. For example, the increased sweat secretion can be clearly observed on the skin in some regions of the body, while some regions have no sweat production.

By administration of cocaine and amphetamine – eye drops, the damage can be located and their dimensions were identified. The physical impairment affects only the eye and the eye muscles. For example, due to the narrowing of the pupils, the perception behavior of the eye can change in a negative sense, the visual field is reduced by the drooping eyelid and three-dimensional vision can be significantly impaired.

Mostly, patients with Horner’s syndrome suffer particularly from psychological stress, since the facial expressions and appearance can change significantly due to the symptoms.

In the further course, it must be concluded why the symptoms of Horner’s syndrome are occurring and which other disease is responsible for it. This is the only way to effectively treat the symptoms.(3)(5)

Therapies For Horner’s Syndrome

No special therapy has been developed for the treatment of Horner’s syndrome. This is mainly due to the fact that many different causes can result in the symptoms of Horner’s syndrome.

Treatment of the actual disease – which is the cause of Horner’s syndrome – should be the primary objective.

The treatment is always tailored to the patient’s actual suffering and goes hand in hand with the treatment of the causative disease. If the treatment improves the state of health, in most cases the Horner’s syndrome will also improve.

If the symptoms of Horner’s syndrome cannot be relieved, other causes of these symptoms should be looked upon.(5)


  1. Flores S, Riguzzi C, Herring AA, Nagdev A. Horner’s syndrome after superficial cervical plexus block. Western Journal of Emergency Medicine. 2015;16(3):428.
  2. Agarwal PK, Lim LT, Park S, Spiteri-Cornish K, Cox A. Alternating Horner’s syndrome in multiple sclerosis. Paper presented at: Seminars in ophthalmology2012.
  3. Davagnanam I, Fraser C, Miszkiel K, Daniel C, Plant G. Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm. Eye. 2013;27(3):291-298.
  4. Mangat SS, Nayak H, Chandna A. Horner’s syndrome and sixth nerve paresis secondary to a petrous internal carotid artery aneurysm. Paper presented at: Seminars in ophthalmology2011.
  5. Pollard ZF, Greenberg MF, Bordenca M, Lange J. Atypical acquired pediatric Horner syndrome. Archives of Ophthalmology. 2010;128(7):937-940.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 28, 2020

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