Horner Syndrome: Causes, Symptoms and Treatment

Horner's Syndrome, also known as oculosympathetic palsy, is a condition that happens due to damage to the sympathetic nerves supplying the eye and nearby facial muscles. The nerve affected in Horner's syndrome is responsible for controlling the eyelids, pupil size, and sweating on the face.

When this nerve gets damaged, it leads to a combination of symptoms like drooping eyelids, constricted pupils, and reduced sweating on one side of the face.

Though Horner's syndrome is not life-threatening, it could indicate an underlying health issue, such as a stroke, tumour, or nerve injury, that needs immediate attention. Early diagnosis and treatment are important to manage the symptoms and address the root cause.

Causes of Horner Syndrome

Understanding the causes of Horner Syndrome is very important for diagnosing and managing the condition properly. The causes of Horner syndrome can be broadly classified based on the location of the nerve damage.

Central Causes of Horner Syndrome

Central causes refer to damage in the brain or spinal cord where the sympathetic nerves are located. These causes are often linked to:

Stroke: Damages blood flow to brain, interferes with sympathetic pathway
Tumors: Brain tumors may compress or infiltrate the sympathetic nerves and give rise to Horner syndrome.
Multiple Sclerosis: Where the body’s immune system attacks the body’s nervous system, kissing the sympathetic nerves.
Trauma: Injury to the brain or spinal cord may affect the sympathetic nerves and lead to Horner syndrome.

Preganglionic Causes of Horner Syndrome

Preganglionic causes happen when there is damage to the nerve fibers between the spinal cord and the sympathetic ganglion (a cluster of nerve cells). This can be caused by:

Chest Tumors: Tumors, like lung cancer, can affect the sympathetic nerves running through the chest area.
Neck Injuries: Trauma or surgeries in the neck can cause damage to the sympathetic nerves.
Aortic Aneurysm: This is an abnormal bulge in the aorta that can press against the sympathetic nerves, causing Horner syndrome.

Postganglionic Causes of Horner Syndrome

Damage to the nerve fibers connecting the sympathetic ganglion and the eye is one of the postganglionic causes. These factors are connected to:

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Carotid Artery Dissection: Horner syndrome can result from a carotid artery tear that affects the sympathetic nervous system.
Cluster Headaches: The sympathetic nervous system may be momentarily harmed by severe headaches.
Middle Ear Infections: Horner syndrome can result from middle ear infections that extend to neighboring sympathetic nerves.

Understanding these causes of Horner syndrome is essential for doctors to properly diagnose and treat the condition.

Symptoms of Horner Syndrome

Recognizing the symptoms of Horner syndrome is very important for early diagnosis and treatment. The symptoms of Horner syndrome usually affect one side of the face and eye, and may include:

Ptosis (Drooping Eyelid): Drooping of the upper eyelid, or ptosis, is one of the primary Horner syndrome symptoms. This occurs when the muscles surrounding the eye weaken, resulting in the eyelid falling.
Miosis (Constricted Pupil): Miosis, or constriction of the pupil, is another common symptom of Horner syndrome. The affected pupil is usually smaller than the other and might not dilate properly in low light.
Anhidrosis (Reduced Sweating): Anhidrosis means reduced or absent sweating on one side of the face. This happens because the sympathetic nerves that control sweating are affected by the condition.
Enophthalmos (Sunken Eye): In some cases, the affected eye may appear sunken or recessed into the eye socket, which is known as enophthalmos.
Heterochromia (Different Colored Irises): In children, Horner syndrome symptoms can lead to heterochromia, where the affected eye has a different color than the other eye. This is because nerve signals affecting the pigmentation of the iris are disrupted.

Recognizing these Horner syndrome symptoms is key for getting timely diagnosis and proper treatment.

Diagnosis of Horner Syndrome

Horner Syndrome diagnosis is based on a combination of the clinical examination and tests to identify the underlying cause.

Clinical Examination

The initial diagnosis process often begins with a complete clinical examination. The physician will look for the classic symptoms of Horner Syndrome, which are anhidrosis, miosis and ptosis. They may also do a pupil dilation test to check how the pupils react to light.

Imaging Tests

Imaging tests are crucial in identifying the underlying cause of Horner Syndrome. These may include:

MRI (Magnetic Resonance Imaging): To detect brain or spinal cord abnormalities.
CT Scan (Computed Tomography): To identify tumors, aneurysms, or other structural issues in the chest or neck.
Carotid Ultrasound: To check for carotid artery dissection.

Pharmacological Tests

Pharmacological tests involve the use of eye drops to help diagnose Horner Syndrome. Two common tests are:

Cocaine Test: Cocaine eye drops will dilate a normal pupil but have little effect on a pupil affected by Horner Syndrome.
Apraclonidine Test: Apraclonidine eye drops will cause the affected pupil to dilate more than the normal pupil, indicating Horner Syndrome.

Treatment Options for Horner Syndrome

The main focus of treatment for Horner syndrome is to address the root cause of the condition. Depending on what is causing the problem, Horner syndrome treatment can include the following options:

Medication

If the cause is an infection or inflammation, doctors may prescribe antibiotics or anti-inflammatory medicines to treat the issue.

Surgery

In cases where the symptoms are caused by tumors or aneurysms, surgery might be needed to remove or fix the affected area.

Managing Signs

Along with treating the underlying cause, managing the symptoms of Horner syndrome helps improve the patient’s quality of life. This can involve:

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Eye Drops: These may be used to manage ptosis (drooping eyelid) and miosis (constricted pupil).
Physical Therapy: Aimed at strengthening muscles and improving function in the affected area, making recovery more comfortable.

This holistic approach to Horner syndrome treatment ensures that each patient receives a well-rounded and effective care plan tailored to their needs.

Living with Horner Syndrome

But with the proper administration and support, living with Horner Syndrome can be a manageable condition. It is very important to visit the doctor regularly to monitor your health and to update the treatment in case it is necessary, we can give you the best care possible.

Support Networks

In addition to emotional support, a support group can offer practical advice. Finding support from those who can relate to what you’re experiencing can be incredibly consoling and a way to receive meaningful advice.

Lifestyle Adjustments

Some lifestyle changes, such as wearing sunglasses to shield your eyes from bright light and eying moisturizing eye drops, can help you manage your symptoms and feel better. These small changes can have a huge impact on your day to day life.

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Frequently Asked Questions

In Horner's syndrome, the sympathetic nerve pathway is damaged. This pathway involves a series of nerves that control certain functions of the eye, eyelids, and surrounding muscles. The damage can occur anywhere along this pathway, including the brain, spinal cord, or the eye region.

The superior cervical ganglion is typically affected in Horner's syndrome. This ganglion is part of the sympathetic nervous system and is located near the neck. Damage to this ganglion disrupts the sympathetic nerve signals to the eye, leading to the symptoms of Horner's syndrome.

The classic triad of Horner's syndrome includes ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face. These three symptoms are typically seen together in patients with Horner's syndrome.

The carotid artery is often involved in Horner's syndrome. Specifically, a carotid artery dissection, which is a tear in the artery, can damage the sympathetic nerve fibers that travel alongside the artery, leading to Horner's syndrome.

Yes, an eye exam can help detect Horner's syndrome, particularly by identifying symptoms such as ptosis (drooping eyelid) and miosis (constricted pupil). Special tests, such as the cocaine eye test or apraclonidine test, can further help in confirming the diagnosis. However, additional imaging and diagnostic tests may be needed to identify the underlying cause of the nerve damage.