Is Horner’s Syndrome A Progressive Disease & Alternative Treatments For It?

A consequence of a paralysis of the ocular sympathetic nerve, Horner’s syndrome manifests itself by ptosis of the upper eyelid, a narrowing of the pupil and an absence of sweating on the side of the affected face. It can be a sign of underlying pathology. Horner’s syndrome is a neurological syndrome affecting part of the face, including an eye.(1)

Is Horner’s Syndrome Progressive?

The progressive pattern of Horner syndrome depends on the underlying cause of the disease. In many cases, symptoms of Horner syndrome disappear as soon as the underlying condition is resolved. In other cases, no treatment can be done. Children with Horner syndrome have problems with a proper diagnosis. It is not clear whether these signs appeared or were obtained at birth. It can be said that in some cases the condition may become worse, but the long-term follow-up of these cases did not show any progressive nature.(2)

Treatment depends on the underlying disease that causes Horner syndrome. There are many possible causes, so the type of treatment can vary greatly. Sometimes, no treatment is needed unless the patient feels pain or other discomforts. If you find a tumor or other issues, you can choose surgery. If the tumor is malignant, postoperative treatment may include chemotherapy and radiotherapy.(1)(3)

With a family history of Horner syndrome, genetic counseling may be helpful.

Alternative Treatments For Horner’s Syndrome

It is difficult to suggest any direct lifestyle changes or home remedies or alternative treatment options for Horner’s syndrome as the disease has no one or specific cause behind it. Once a proper diagnosis is made and the underlying cause of the disease is understood you may think of lifestyle changes or alternative treatments to manage that cause. There are some reports of treating Horner’s syndrome through acupuncture in dogs.(4)

Horner’s syndrome can occur spontaneously (primitive form), or be the consequence of damage to the fibers of the sympathetic nervous system innervating the orbit. Some of them descend along the spinal cord, leave it to emerge in the thorax and then go up along the neck to the eye. Also, a lesion or compression on the path of these nerve fibers can lead to Claude Bernard-Horner syndrome. This lesion can be central (in the brain) or peripheral (in a sympathetic cervical trunk).

Causes at a glance:

  • A cerebral vascular accident
  • A tumor, especially of the lung, which compresses the sympathetic nerve
  • Carotid dissection
  • Cervical lymphadenopathy (lymph nodes in the neck)
  • Cervical spine surgery (rare)
  • Note that there are also congenital forms of Claude Bernard-Horner syndrome.(5)

Symptoms Of Horner’s Syndrome

The symptoms of Horner’s syndrome appear on the side of the face where the nerve fibers are damaged. They combine:

Upper eyelid ptosis: the upper eyelid falls due to paralysis of the smooth muscle fibers associated with the lift of the upper eyelid;

Constriction of the pupil (miosis), due to a paralysis of the dilator muscle of the pupil. The pupil is narrowed, but generally has no impact on vision, or rarely on night vision in some patients;

A decrease in sweating on the side of the affected face, sometimes with episodes of redness.

Diagnostic Procedures For Horner’s Syndrome

Confirmation of the diagnosis of Horner’s syndrome is based on the eye examination after the administration of cocaine eye drops (4 or 10%) or apraclonidine (0.5 or 1%).

Cocaine is an indirect sympathomimetic: it causes dilation of the pupil. During Horner syndrome, the affected pupil will not dilate as well as the other pupil. Apraclonidine has an action on certain receptors of pupillary dilation. In the case of Horner’s syndrome, it will cause dilation of the pupil.

If the diagnosis of Horner’s syndrome is confirmed, 48 hours later an ophthalmic test using drops of hydroxyamphetamine can be performed to locate the lesion, pre- or postganglionic.

The triad of Horner’s syndrome, unilateral pain in the head, face and neck and, a few hours or days later, a homolateral ischemic or retinal ischemia evokes carotid dissection. The cervical color Doppler ultrasound is then the first line examination.

Depending on the clinical context, an MRI of the brain, spinal cord, thorax or neck may be prescribed in order to locate the lesion, and screen for any pathology causing the syndrome.(6)

References:

  1. Khan Z, Bollu PC. Horner syndrome. StatPearls [Internet]: StatPearls Publishing; 2019.
  2. Jacobs SM, Tyring AJ, Amadi AJ. Traumatic ptosis: Evaluation of etiology, management and prognosis. Journal of ophthalmic & vision research. 2018;13(4):447.
  3. Sharp O, Wong KY, Stephens P. Backpack palsy with Horner’s syndrome. Case Reports. 2017;2017:bcr-2017-219402.
  4. Cho S-J, Kim O. Acupuncture treatment for idiopathic Horner’s syndrome in a dog. Journal of veterinary science. 2008;9(1):117-119.
  5. Agarwal PK, Lim LT, Park S, Spiteri-Cornish K, Cox A. Alternating Horner’s syndrome in multiple sclerosis. Paper presented at: Seminars in ophthalmology 2012.
  6. González-Aguado R, Morales-Angulo C, Obeso-Agüera S, Longarela-Herrero Y, García-Zornoza R, Cervera LA. Horner’s syndrome after neck surgery. Acta Otorrinolaringologica (English Edition). 2012;63(4):299-302.

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