Horner syndrome

Horner syndrome is a rare condition that affects the nerves to the eye and face. It is a clinical syndrome caused by damage to the sympathetic nervous system. Lesions at any point along the sympathetic pathway may result in Horner syndrome

Causes Horner syndrome can be caused by any interruption in a set of nerve fibers that start in the part of the brain called the hypothalamus and run to the face. Sympathetic nerve fiber injuries can result from:

Injury to one of the main arteries to the brain (carotid artery) Injury to nerves in the neck called the brachial plexus Migraine or cluster headaches Stroke, tumor, or other damage to a part of the brain called the brainstem Tumor in the top of the lung

Rarely, Horner syndrome may be present at birth (congenital). The condition may occur with a lack of color (pigmentation) of the iris (colored part of the eye). Symptoms

Signs found in all patients on affected side of face include; partial ptosis (which is drooping of the upper eyelid from loss of sympathetic innervation to the superior tarsal muscle, also known as Mller's muscle [1]), upside-down ptosis (slight elevation of the lower lid), and miosis (constricted pupil), and anhidrosis (decreased sweating on the affected side of the face), dilation lag (slow response of the pupil to light), Enophthalmos (the impression that the eye is sunk in) loss of ciliospinal reflex and bloodshot conjunctiva may occur depending on the site of lesion. Sometimes there is flushing of the face is on the affected side of the face due to dilation of blood vessels under the skin. The clinical features of Horner's syndrome can be remembered using the mnemonic, "Horny PAMELa" for Ptosis, Anhidrosis,
1

Miosis, Enophthalmos (recession of the eyeball within the orbit) and Loss of ciliospinal reflex. (The ciliospinal reflex (pupillary-skin reflex) consists of dilation of the ipsilateral pupil in response to pain applied to the neck, face, and upper trunk. If the right side of the neck is subjected to a painful stimulus, the right pupil dilates This reflex is absent in Horner's syndrome and lesions involving the cervical sympathetic fibers.)

In children Horner syndrome sometimes leads to a difference in eye color between the two eyes (heterochromia). This happens because a lack of sympathetic stimulation in childhood interferes with melanin pigmentation of the melanocytes in the superficial stroma of the iris. Investigations Physical Important aspects of the physical examination include the following:

Measurement of pupillary diameter in dim and bright light and their reactivity to light and accommodation Examination of the upper lids for ptosis Examination of the lower lids for upside-down ptosis (eg, position of the lower lid with respect to the inferior limbus) Extraocular movements Biomicroscopic examination of the pupillary margin and iris structure and color Confrontational visual field testing and testing of facial sensation Observation for the presence of nystagmus, facial swelling, lymphadenopathy, or vesicular eruptions

Other tests may include:

Blood tests Blood vessel tests (cerebral angiogram, CT angiogram, or MR angiogram Chest x-ray or chest CT scan MRI or CT scan of the brain Spinal tap (lumbar puncture)