Horner’s Syndrome/ Oculosympathetic Paresis

Definition: Horner syndrome (Horner’s syndrome or oculosympathetic paresis) results from an interruption of the sympathetic nerve supply to the eye.

Etiology: Horner syndrome is a rare disorder that affects males and females in equal numbers and may occur at any age, among any ethnic grouping in any geographic location.

Right-sided Horner’s syndrome due to paravertebral
metastasis at T1. There is ipsilateral partial ptosis and a small pupil.

It is always ipsilateral.

The term Horner syndrome is commonly used in English-speaking countries, whereas the term Bernard-Horner syndrome is common in France.

The congenital, and more rare, form of Horner syndrome is present at birth but the cause is not known. Most often, Horner syndrome is acquired as a result of some kind of interference with the sympathetic nerves serving the eyes. 

Causes:

  • Cervical Sympathetic Fiber Leison.(some lumber also)
  • Apical Bronchogenic Carcinoma
  • Syringomyelia
  • Syringobulbia

Clinical Feature:

  • Ipsilateral Partial Ptosis.
  • Miosis.
  • Ipsilateral Anhidrosis.
  • Enopthalmos.
  • Ipsilateral Facial Flushing.

If the onset of Horner syndrome is before two years of age, the colored portions of the eyes (irises) may be different colors (heterochromia iridis). In most cases, the iris of the affected side lacks color (hypopigmentation).

Left-sided Horner’s syndrome

Diagnosis:

  1. Magnetic resonance imaging.
  2. Ultrasonography of the carotid artery.
  3. Three tests are useful in confirming the presence and severity of Horner syndrome:
    • Cocaine drop test.
    • Paredrin test.
    • Dilation lag test.

Management:

  • Depends on the location and cause of the lesion or tumor.
  • Some cases surgical removal of the lesion or growth.
  • Chemotherapy may be beneficial to patients with malignant tumors.
  • Genetic counseling in cases of genetic form of this disorder.
  • Symptomatic and supportive treatment

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