Horner’s syndrome affects the part of the face, causing the eyelid to fall, the pupil to constrict, and increased sweating. It is caused by a disruption of the nerve fibers that connect the brain to the eye.(1)
Horner’s syndrome can manifest itself spontaneously or result from a disorder that disrupts the nerve fibers connecting the brain to the eye. The upper eyelid falls, the pupil remains small and the side of the affected face can sweat less. Doctors test the pupil to see if it can expand, and can perform imaging to find a cause. Once identified, the cause is treated.
What Are The Ways To Prevent Horner’s Syndrome?
You may take some steps to prevent Horner’s syndrome. However, it is difficult as the condition may happen due to various reasons. Prevention strategies depend on the cause of Horner syndrome. These measures may include preventing shock (especially head trauma), controlling cardiovascular risk factors and quitting smoking. Parental genetic counseling may help prevent congenital cases.(2)
Does Horner’s Syndrome Reoccur?
The chances of reoccurrence of Horner’s syndrome depend on the underlying cause. The symptoms may go away by itself or when treating the underlying cause. If the same or different causes reappear in later part of life, you will experience Horner’s syndrome again.(2)(3)
Some of the nerve fibers that connect the eyes to the brain take a roundabout way. From the brain, they descend along the spinal cord. They come out of the spinal cord, emerge in the thorax, then go up along the neck, around the carotid artery until in the cranium and the eye. So, it is a diverse and long route, and if these nerve fibers are damaged at any point in their path, it results in a Horner’s syndrome.
The syndrome can manifest itself spontaneously or be caused by another disorder. For example, it can result from diseases of the head, neck, brain or spinal cord, such as:
- Dissection of the carotid artery or aorta (tear in the arterial wall envelop)
- Injuries in the neck, head or spinal cord
- It may be present at birth as well (congenital disease)
- Lung cancer
- Other tumors
- Swollen lymph nodes in the region of the neck (cervical lymphadenopathy)
- Thoracic aortic aneurysm (lump in the wall of the aorta)(4)
Symptoms Of Horner’s Syndrome
Horner’s syndrome affects the eye on the same side as the damaged nerve fibers.
Symptoms of the syndrome include a drooping upper eyelid (ptosis) and a narrowed pupil (miosis). In some people, the narrowing of the pupil interferes with the night vision. However, most people do not notice any difference in vision.
The side of the affected face may sweat less than normal or may not have any sweat, and in rare cases, appear red.
In the congenital form of the disease, the iris of the affected eye remains blue-gray in color, as at birth. This makes doctors suspect the disease and conduct other tests to confirm.(2)
Diagnostic Process For Horner’s Syndrome
The diagnosis process involves the following tests:
- Eye drops testing (to dilate the pupils for better examination)
- Magnetic resonance imaging or computed tomography to identify the cause
- Horner’s syndrome is suspected based on symptoms.
To confirm the diagnosis of Horner’s syndrome and determine the location of the problem, doctors perform a two-part examination:
The doctor will give cocaine containing eye drop along with apraclonidine to the affected and normal eyes. If the syndrome is likely to be present, doctors re-examine it 48 hours later. They apply drops of hydroxyamphetamine in both eyes. How the pupils react to medication indicates whether Horner’s syndrome is likely and helps locate the location of the problem.
MRI or CT scan of the neck, brain, chest or spinal cord is often necessary to look for tumors and other serious disorders that can prevent nerve fibers from connecting to the brain and eyes.(4)
Treatment Courses For Horner’s Syndrome
Treatment of the cause, subject to identification is the main approach taken by the doctors to heal patients with Horner’s syndrome.
If identified, the cause of Horner’s syndrome is treated. However, there is no specific treatment for the syndrome and often no treatment is necessary, because in general, the fall of the eyelid is only slight.(2)
- 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.
- Liu Q, Huang B, Chen Y, et al. Prevention and treatment of Horner syndrome in treatment of head and face hyperhidrosis by thoracic sympathetic nerve modulation. Zhonghua yi xue za zhi. 2017;97(46):3624-3627.
- Henry M, Johnson C, Ghadiali L, Raiji V. Horner’s Syndrome Following Varicella Vaccination. Neuro-Ophthalmology. 2019:1-3.
- 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.
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