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The face and eye on one side of the body may be impacted by Horner syndrome. The condition caused by a disturbance of the nerve pathway from the brain to the head and neck.
The sympathetic nerves that connect your brainstem to your eyes and face are disrupted, which causes it to happen. These nerves regulate involuntary functions, including sweating (perspiration) and the constriction and dilation of your eye pupils.
Horner syndrome frequently manifests as drooping eyelids, smaller pupils, and reduced facial perspiration on the affected side.
A stroke, tumor, spinal cord damage, or another medical condition may cause Horner syndrome. Sometimes there is no underlying reason for a problem. Horner syndrome doesn’t have a specific treatment, however addressing the underlying cause may help nerve function return.
Oculosympathetic palsy and Bernard-Horner syndrome are other names for Horner syndrome.
Symptoms
Only one side of the face is often affected by Horner syndrome. Typical warning signs and symptoms include:
- Miosis or constricted pupil
- A significant disparity between the size of the pupils in the two eyes (anisocoria)
- The affected eye appears sunken.
- Slow or delayed dilation of the afflicted pupil in low light
- Ptosis where in the upper eyelids appear to drop
- Upside-down ptosis, a slight elevation of the lower lid.
- Little to no facial perspiration (anhidrosis) on the afflicted side
Ptosis and anhidrosis are two signs and symptoms that might be subtle and challenging to recognize.
Children
Children with Horner syndrome may sometimes show additional symptoms like:
- A child under the age of one with a lighter iris color in the afflicted eye
- A change in hue on the side of the face that is being impacted, which is often brought on by heat, physical activity, or emotional responses.
Horner syndrome can be brought on by several things, some of which are more significant than others. Obtaining a timely and correct diagnosis is crucial.
Get immediate medical attention if Horner syndrome symptoms occur unexpectedly, follow a traumatic event, or are accompanied by other symptoms, such as:
- Eyesight problem
- Dizziness
- Slurring of speech
- Walking problem
- Weakness or poor control of the muscles
- A sudden or severe headache or neck pain
Causes
Damage to a specific sympathetic nervous system circuit results in Horner syndrome. The sympathetic nervous system controls your heart rate, breathing, sweating, blood pressure, and other bodily processes that let you react promptly to environmental changes.
There are three different types of nerve cells (neurons) along the nerve pathway that are impacted by Horner syndrome.
First-order neurons
The hypothalamus at the base of the brain serves as the starting point for this neuron pathway, which continues via the brainstem and into the upper part of spinal cord. Horner syndrome-related issues in this area that may impair nerve function include:
- Tumor
- Stroke
- Conditions that result in the loss of neurons’ myelin sheaths
- Syringomyelia or cyst growth in the spinal column
- Trauma on the neck
Second-order neurons
From the spinal column, this neuron tract travels through the upper chest and into the side of the neck. The following factors could contribute to nerve injury in this area:
- Having schwannoma or myelin sheath tumor
- Malignancy in the lung
- Surgical intervention in the chest
- Impactful or traumatic injury
- Damage to the aorta
Third-order neurons
Damage to this neural pathway, which runs alongside the neck, and leads to facial skin, muscles controlling the iris and the eyelids. Impairment in this area can be linked to the following conditions or symptoms:
- Migraines
- Cluster headaches
- An injury to the carotid artery on the side of the neck
- An injury to the jugular vein on the side of the neck
- An infection or tumor close to the skull’s base
Children
Children’s Horner syndrome is most frequently caused by:
- Neck or shoulder injuries sustained during childbirth
- Aortic anomaly present at birth
- Neuroblastoma, a tumor of the neurological and hormonal systems.
Unknown causes
In some circumstances, it is impossible to determine what causes Horner syndrome. Idiopathic Horner syndrome is the term for this.
Diagnosis
Your doctor will likely do tests in addition to a standard physical in order to ascertain the specifics of your symptoms and pinpoint a potential cause.
Horner syndrome diagnostic test
Based on your medical history and an evaluation of your symptoms, your doctor might be able to identify Horner syndrome.
By administering a medicated eye drop to both eyes, either one that will enlarge the pupil of a healthy eye or one that will constrict contract it, an eye specialist (ophthalmologist) can further confirm a diagnosis. The doctor can assess whether nerve damage is the root of issues in the suspect eye by comparing the responses in the healthy eye and that of the suspect eye.
Tests to find the damaged nerve area
Your symptoms may help your doctor focus on a more specific Horner syndrome cause. For the purpose of identifying the lesion or abnormality obstructing the nerve pathway, your doctor may also do further tests or request imaging studies.
If a third-order neuron irregularity—a disruption somewhere in the neck or above—is what causes Horner syndrome, your doctor may deliver an eye drop that dramatically dilates the healthy eye and only slightly dilates the problematic eye.
In order to identify the location of a potential irregularity causing Horner syndrome, your doctor might request one or more imaging tests from the list below:
- Chest X-ray
- Computerized Tomography (CT), a special X-ray imaging.
- Magnetic Resonance Imaging (MRI), a method that creates precise images by combining radio waves and a magnetic field.
- MRA, or Magnetic Resonance Angiography, is a procedure used to assess blood vessels.
Treatment
The Horner syndrome has no specific treatment. When an underlying medical issue is successfully treated, Horner syndrome frequently goes away.
