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What Are The First Symptoms Of Horner’s Syndrome & How Do You Test For It?

What Are The First Symptoms Of Horner’s Syndrome?

Horner syndrome is a sympathetic disorder in which the sympathetic ganglion located in the cervical region is affected. Most of the symptoms of horner’s syndrome are associated with defects in the eye and sometimes can also involve a part of the face. Horner syndrome is having a presentation with a few characteristic features like ptosis, miosis, anhidrosis, heterochromia iridis, loss of ciliospinal reflex and apparent enophthalmos.(1)

In ptosis, there is drooping of eyelid on the affected side as compared to the normal side and it is considered clinical only if the drooping is greater than 2 mm. Since the sympathetic system is responsible for mydriasis of the pupils, loss of sympathetic system results in miosis which can be better appreciated during the night time because even after getting so dark environment the pupils do not dilate as much as compared to the normal ones.

The sympathetic system is also responsible for providing the color to the iris in the eye and when the sympathetic system gets affected as in horner’s syndrome the color of the iris of the same side is reduced and there seems to be a variation of the colors of iris on both sides known as heterochromia iridis. In horner syndrome, there is apparent enophthalmos which means it looks likes the eyes are deeply sunken but in reality, they are not. The reason for this condition is not clear so far.

Anhidrosis is a condition in which there is no sweating from the affected part of the skin. Since sweating is related to a sympathetic activity which is downgraded in horner syndrome hence the condition also is found in a few patients of horner’s syndrome. Also, the ciliospinal reflex is lost due to the defect of sympathetic supply from the spinal cord to the eyes responsible for it.

How Do You Test For Horner’s Syndrome?

First of all, the history taking in the case of horner’s syndrome is very important because it not only helps in the chronology of the symptoms but also as well as helps in understanding the level of the lesion in the sympathetic pathway. General physical examination is the next and most important part which will help to locate the lesions responsible for horner syndrome in the individual.

For the determination of the miosis, the pupillary diameter should be measured in the dim light as well as normal light to distinguish defects from the normal eye. As soon as lights of the room are switched off the pupillary diameter is checked to measure the dilation lag of the pupil. Upper and lower eyelid measurements are done so as to find the ptosis and its extent.

Bio microscopic examination of the iris, its border, its structure, and its color is done which helps to differentiate the heterochromia iridis. Visual field testing is also done to determine any defects in the visual acuity of the eye. Various sensations on the face including the touch and pain sensation, sweating is also checked to determine the anhidrosis associated with horner’s syndrome.


Horner syndrome is a group of symptoms arising from the defect of the sympathetic system supplying to the eye and surrounding areas and can arise due to a variety of causes ranging from trauma to the malignancy. Since it is a syndrome it comprises a group of symptoms, out of which 6 symptoms are the most important and most frequently found in it. The symptoms are to be checked in every patient in whom the horner’s syndrome is suspected.

History taking and general physical examination are the most important part which helps to localize the cause and the lesion responsible for horner’s syndrome in the individual. After that comes the localized examination of the lesion and the affected areas of the body. Eyes and face are the most common parts of the body to be affected in it.


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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 27, 2020

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