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Who Is At Risk For Horner’s Syndrome & Is There A Blood Test For It?

Horner’s syndrome is the disruption of sympathetic nerve innervation to the eye and face. Johann Friedrich Horner, an ophthalmologist from Switzerland first described Horner’s syndrome in 1869. It is also linked with cluster headaches and migraines in some cases. It can be acquired through injury, stroke, tumor, disruption of the main artery of the neck, or accidental complication of surgery or in rare cases, it may be congenital 1.(1)

Who Is At Risk For Horner’s Syndrome?

The following factors may increase the likelihood of Horner’s syndrome:

Neck and shoulder injuries at birth, stroke, blood clot or abnormality in the carotid anatomy, trauma or surgery involving the chest, neck or the upper spinal cord. There is also a chance of having Horner’s syndrome due to congenital abnormality.

The occurrence of Horner’s syndrome is similar in all races, between all ages, and in both sexes. It is not more or less prevalent in any particular part of the world.(2)

The following symptoms indicate Horner’s syndrome:

Absence of sweat on face

  • A headache
  • Drooping eyes (or one eye) in face
  • Lack of iris pigmentation
  • Pain
  • Tightening of one side of the face

In young children, Horner’s syndrome can sometimes present additional symptoms:

The skin on the affected side of the face may not be flushed (redden) under conditions that typically cause flushing (eg, emotional stress, hot weather, physical exertion). In some cases, the reverse may occur — the affected side of the face will see continuous sweating.

The affected eye iris sometimes may appear pale or lighter compared to the normal eye, particularly in infants suffering from the disease from birth.(2)

Is There A Blood Test For Horner’s Syndrome?

There are some blood tests for Horner’s syndrome diagnosis. Your doctor may need to test your blood or urine for health problems that can cause nerve damage.

The following laboratory tests and procedures are used to detect Horner’s syndrome:

  • Magnetic Resonance Imaging (MRI) Scan: It is performed to produce detailed images of the site of nerve damage
  • X-ray Imaging: It is done to detect lesions or abnormalities that obstruct the neural pathway
  • Paredrine Test: An eye test that helps to localize the cause of miosis.(2)

Prevention From Horner’s Syndrome

Yes, it is possible to prevent congenital Horner’s syndrome. Prevention can be possible by having genetic counseling of the expected parents.

Treatment For Horner’s Syndrome

The disease cannot be treated but it is possible to maintain or keep the effects to minimal. Horner’s syndrome may cause complications if it is not treated timely or left untreated.

Since Horner’s syndrome is a greater accumulation of symptoms related to a disease, treatment, and prognosis will depend on the cause of the symptoms.(2)

Common Causes Of Horner’s Syndrome

The following are the most common causes of Horner’s syndrome:

  • Carotid artery injury
  • Sympathetic nervous system pathway damage
  • Migraine
  • Strokes
  • Tumor in the top of the lung

The sympathetic nervous system is responsible for automatic functions in the body, especially those involving automatic responses to our environment. These roles may include sweating, heartbeat regulation, controlling blood pressure along with the pupil constriction and dilation to light responses.

Horner’s syndrome may be present due to damage in the pathway of the sympathetic nervous system. In cases in which the condition is acquired through injury, this damage may result from a stroke, tumor, or trauma to the neck, especially if it damages the carotid artery or jugular vein — walking through the neck. For the two major blood vessels – the brachial plexus, there is a network of nerves running through the neck.

Rarely, a carotid amputation can occur spontaneously, without a known cause. It occurs when blood travels to the middle layers of the carotid artery, and should be treated as an emergency. It is usually associated with neck or eye pain.

Congenital or by birth Horner’s syndrome may happen because of a head or neck injury at the time of birth and usually, the aorta gets affected (which is the primary artery extending from heart to abdomen), or by a tumor of the nervous system known as neuroblastoma. However, in many cases, congenital Horner is idiopathic, meaning that there is no apparent cause.(3)(4)


  1. Smit DP. Pharmacological testing in Horner’s syndrome–a new paradigm. South African Medical Journal. 2010;100(11):738-740.
  2. 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.
  3. 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.
  4. Smith SJ, Diehl N, Leavitt JA, Mohney BG. Incidence of pediatric Horner syndrome and the risk of neuroblastoma: a population-based study. Archives of Ophthalmology. 2010;128(3):324-329.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 26, 2020

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