Horner’s syndrome, also called Oculoplastic paralysis, is a rare condition caused by an interruption in nerve transmission from the brain to the face and eyes on one side of the body, resulting in a decrease in the size of the pupil, a drooping eyelid and loss of control of sweat on the side of the affected face.
This syndrome can result from a medical problem, such as a stroke, a tumor or spinal cord injury, for example, or even from an unknown cause. The resolution of Horner’s syndrome is the treatment of the cause that causes it 1.(1)
Does Horner’s Syndrome Cause Pain?
Horner’s syndrome is characterized by falling upper eyelids, dilated pupils, eyelid stenosis, hyperhidrosis (less sweating), and different pupil sizes between the two eyes, present in up to 58% of the internal carotid anatomy. Because of ischemia or the expansion of the trigeminal nerve fibers around the carotid artery, most patients experience pain in the head, face, and neck on the same side of the lesion. Eye symptoms have been reported in up to 62% of patients with internal carotid anatomy.
Common outcomes of recurrence of pain due to the rupture of sympathetic nerve fibers in third-degree neurons and transient monocular vision loss or permanent vision loss are possible. So, pain is a possibility in Horner’s syndrome.(2)
What Does Horner’s Syndrome Look Like?
Horner’s syndrome – symptom complex, caused by damage to the sympathetic nervous system, are Ophthalmological impairment, disorders of sweating and vascular tone on the affected side. The clinical picture is represented by ptosis, miosis, endophthalmitis in combination with hyperemia and dyshidrosis of the face half. The affected eye is administered with oxamphetamine followed by eye biomicroscopy, CT of the eye sockets, and reaction test. The therapeutic tactic is reduced to the appointment of electrical neurostimulation and possible correction of cosmetic defects through plastic surgery.(3)
Common Symptoms Of Horner’s Syndrome
- Anisocoria, which consists of a difference in pupil size between the two eyes;
- Delayed dilation of the pupil of the affected eye;
- Drooping eyelid in the affected eye;
- Elevation of the lower eyelid;
- Myositis, which consists of a decrease in the size of the pupil;
- Decrease or absence of sweat production of the affected side.
When this disease develops in children, symptoms or changes in the color of the iris of the affected eye, which may become lighter, especially in children under the age of one, redness on the affected side of the face, may appear. Normally appears in situations such as exposure to heat or emotional reactions.(4)
Causes And Risk Factors For Horner’s Syndrome
Facial and optical nerve fiber interruptions going in and out of hypothalamus (an important part of the brain) may cause Horner’s syndrome. Injury to sympathetic nerve fibers can result from injury to one of the main arteries to the brain (carotid artery), injury to the nerves at the base of the neck called the brachial plexus, migraine or tension headache, stroke brain, tumor, or other damage to a part of the brain called the brainstem, a tumor in the upper lung.
In children, the most common causes of Horner’s syndrome are injuries to the baby’s neck or shoulders during delivery, aortic abnormalities already present at birth, or tumors.(4)
Diagnosis And Treatment For Horner’s Syndrome
Blood and imaging tests are done to determine the cause of the syndrome. An eye exam can show:
- Alterations in closing and opening of the pupil
- Drooping eyelids
- A complete and nervous (neurological) medical system the exam can show if all other parts of the body are affected. Other tests may include blood tests, blood vessel tests (cerebral angiography, CT scan, angiography or MR chest x-ray or IRM chest CT or spinal tap brain scanner (lumbar puncture).
- You may need to be referred to a doctor who specializes in vision problems related to the nervous system (Neuro-ophthalmologist).
- Treatment depends on the cause of the problem. There is no treatment for Horner’s syndrome itself.
Prognosis And Possible Complications Of Horner’s Syndrome
The outcome depends on whether the treatment of the cause is successful.
Horner’s syndrome may not have any direct complications. However, there may be complications from the disease that caused Horner syndrome or its treatment.(5)
- 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.
- 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.
- Khan Z, Bollu PC. Horner syndrome. StatPearls [Internet]: StatPearls Publishing; 2019.
- Nasser BA, Mesned A, Moazamy YE, Kabbani MS. Horner’s syndrome after paediatric cardiac surgery: case report and review of the literature. Cardiology in the Young. 2015;25(3):569-572.
- Smit DP. Pharmacological testing in Horner’s syndrome–a new paradigm. South African Medical Journal. 2010;100(11):738-740.