Horner syndrome is a medical condition in which there is a problem of sympathetic nerve fibers which causes a decrease in the function of the sympathetic nervous system in the eye and face. It sometimes can also involve neck region due to similar territory overlap. There is no known specific treatment for this condition and only the treatment of the underlying cause can be helpful that too even before the damage to the nerve fibers has become permanent. Here few are the coping methods told for each of the symptoms of horner syndrome so as to improve the quality of life.
Coping Methods For Horner’s Syndrome
Ptosis is the most common symptom encountered in the horner syndrome which usually is present on one side of the eye. It occurs due to that of the Muller muscle in the eye which is supplied by the sympathetic system and is responsible for upper eyelid elevation up to the extent of 1 – 2 cm. So, after the loss of function of this muscle, it is associated with mild ptosis of less than 4 cm on the affected eye. To relieve the patient of symptoms of ptosis, a specific surgery is done known as fasanella servat operation. In this surgery, the Muller muscle is excised at its lower end and along with it the upper border of tarsus, associated overlying conjunctiva is also stripped. This is done to shorten the upper eyelid with a few cm margins and finally, the ptosis gets corrected permanently because it is an irreversible procedure.
Miosis is another symptom of horner’s syndrome which deteriorates the quality of life by affecting the accommodation power of the eye. Medical treatment is given in the form of phenylephrine eye drops which not only helps to counter miosis but also can keep the pupil’s size adjusting to the light for some time. These are a cholinergic group of drugs that have the effect of mydriasis in the eye. Multiple dosings in a day can be given to give relief from the symptom.
Heterochromia iridis is another symptom of horner syndrome which is characterized by a change in the color of iris which is also given by the sympathetic pathway supplying to the eye. The color of the affected eye is decreased in texture and it becomes different from the normal eye. In order to come to this dissimilarity, colored contact lenses can be used on the cornea which provides a similar color to both the eyes.(1) It is the only method by which the symptom of heterochromia can be treated. Although, there is research ongoing on the laser treatment for this symptom not much data is available on its success.
Apparent enophthalmos is also seen in this condition but it is only an apparent defect that just appears to be present to the patient when it is not. In reality, there are no enophthalmos present in the horner syndrome. Anhidrosis encountered in the horner’s syndrome cannot be treated but it can be reduced with the help of keeping the skin moist by moisturizer, petroleum jelly, etc. Loss of ciliospinal reflex is another symptom that cannot be treated once lost.
Horner syndrome is a permanent condition that cannot be reversed either medically or surgically by any means because the nervous tissue is a stable tissue. If it gets damaged once then it cannot be regenerated and the function of the tissue is lost forever. Only the symptomatic treatment can be given according to the presenting symptoms as well as the severity of them. Coping methods are taught to the patient so as to live with the horner’s syndrome for whole life with it. Psychological support and counseling are very important from time to time to let the patient not pass into the state of depression because of the constant deterioration of the quality of life.
Some surgical and medical treatments can also be prescribed to reduce the severity of the condition.
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