Horner’s syndrome is a type of eye and facial nerve issues following damage to the fibers of its sympathetic nervous system. Horner’s syndrome is characterized by the appearance of four clinical signs:
- The drooping of the upper eyelid (ptosis). Müller’s smooth orbital muscle, which allows the eyelid to rise, is paralyzed.
- The retraction of the pupil (miosis). The dilator muscle is partially paralyzed. Deprived of light, the eye expands very slowly.
- The receding eyeball in its orbit (enophthalmos).
- The absence of sweating (anhidrosis). The patient does not sweat on the neck and on the profile affected by the lesion.
How Long Will It Take To Recover From Horner’s Syndrome & How Long Do The Symptoms Last?
As already mentioned, the causes behind Horner’s syndrome may vary and it can happen due to various reasons. Therefore, it is difficult to predict the time course and outcome of the treatment. The symptoms may go away quickly if the cause of Horner’s syndrome is treatable and properly understood. If multiple complications and difficult to treat conditions are responsible for Horner’s syndrome, then it may last longer and may not be possible to treat.(2)
In all cases, the appearance of Claude Bernard-Horner syndrome is a sign that the sympathetic nervous system (which organizes most of the body’s unconscious activities) linked to the eye is affected. This oculosympathetic pathway extends from the optic pathways and extends to the base of the neck.
This lesion can have multiple and varied causes. Among them are:
- The stroke: Occurred or likely to occur if the patient suffers from carotid dissection (tearing without rupture).
- Compression of the sympathetic cervical nerve.
- A lesion of the spinal cord or the brainstem following trauma for example.
- A lesion of the spinal bulb.
- A tumor of the hypothalamus.
- The consequences of a surgical operation that affected the oculosympathetic system.
Cancer of the upper lungs. The syndrome occurs when cancer cells reach the root of the 8th cervical nerve. In this case, it can be associated with Pancoast-Tobias syndrome, pain from the shoulder radiating to the arm.
The syndrome can also affect the child. It may then be due to:
- Obstetric trauma: caused by stretching of the brachial plexus (at the neck and shoulder) during a difficult delivery
- Due to neuroblastoma.(2)(3)
What Are The Main Symptoms Of Horner’s Syndrome?
Symptoms of Horner syndrome include:
- A pupil that is smaller than the pupil of the other (normal) eye and does not expand in low light
- Eyelid ptosis (affected eye)
- Reverse ptosis (i.e., a raised lower eyelid)
- The sunken appearance of the affected eye
- A large area of skin that does not sweat on the affected side of the face (anhidrosis)
In young children, Horner’s syndrome can sometimes present additional symptoms:
The skin on the affected side of the face may not blush in conditions that would normally cause hot flashes (for example, heat, physical exertion or emotional stress). In some cases, the opposite can happen – the affected side of the face will have a perpetually flushed appearance.
The color of the affected eye iris may be pale or lighter compared to the normal eye particularly in congenital cases of Horner’s syndrome.(1)(4)
Diagnosis And Treatment For Horner’s Syndrome
- Given the many causes that Horner’s syndrome can have, treatment will vary depending on the cause of its onset.
- To assess the syndrome, the doctor will determine the location of the lesion and perform a full etiological assessment, that is to say, he will look for the causes and factors of this syndrome.
- The doctor may perform several examinations, including an MRI and various pharmacological tests.
- Regression of clinical signs is possible. It is either spontaneous or following the lifting of the compression on the nerve. So, repair surgery is possible in order to lift the eyelid.(1)(2)
Doctors often make the diagnosis easily, unless the signs are not very obvious or some are not clearly visible. In all cases, this syndrome requires immediate management because it can be a consequence of serious pathologies.
Horner’s syndrome owes its name to two doctors, the former French, the other Swiss: Claude Bernard and Johann Horner. Both described it in the second half of the 19th century. However, the first written record of this syndrome dates from 1727. The doctor François Pourfour du Petit had indeed observed it in animals. He also showed that excitation of the intercostal nerves led to the opposite effect.(1)
- Khan Z, Bollu PC. Horner syndrome. StatPearls [Internet]: StatPearls Publishing; 2019.
- Rozen TD, Kline MT. Chronic persistent Horner’s syndrome in trigeminal autonomic cephalalgia subtypes and alleviation with treatment: two case reports. Journal of medical case reports. 2019;13(1):60.
- Wijemanne S, Vijayakumar D, Jankovic J. Apraclonidine in the treatment of ptosis. Journal of the neurological sciences. 2017;376:129-132.
- Henry M, Johnson C, Ghadiali L, Raiji V. Horner’s Syndrome Following Varicella Vaccination. Neuro-Ophthalmology. 2019:1-3.
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