Definition

What is Horner syndrome?

Horner syndrome is a combination of signs and symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body.

Horner syndrome is also known as Horner-Bernard syndrome or oculosympathetic palsy.

How common is Horner syndrome?

Horner syndrome is a relatively rare condition. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of Horner syndrome?

Horner syndrome usually affects only one side of the face. The common symptoms of Horner syndrome are:

  • A persistently small pupil (miosis)
  • A notable difference in pupil size between the two eyes (anisocoria)
  • Little or delayed opening (dilation) of the affected pupil in dim light
  • Drooping of the upper eyelid (ptosis)
  • Slight elevation of the lower lid, sometimes called upside-down ptosis
  • Little or no sweating (anhidrosis) either on the entire side of the face or an isolated patch of skin on the affected side

Signs and symptoms, particularly ptosis and anhidrosis, may be subtle and difficult to detect.

Additional signs and symptoms in children with Horner syndrome may include:

  • Lighter iris color in the affected eye of a child under the age of 1
  • Lack of redness (flushing) on the affected side of the face that would normally appear from heat, physical exertion or emotional reactions

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

A number of factors, some more serious than others, can cause Horner syndrome. It is important to get a prompt and accurate diagnosis.

Get emergency care if signs or symptoms associated with Horner syndrome appear suddenly, appear after a traumatic injury, or are accompanied by other signs or symptoms, such as:

  • Impaired vision
  • Dizziness
  • Muscle weakness or lack of muscle control
  • Severe, sudden headache or neck pain

Causes

What causes Horner syndrome?

Horner syndrome is caused by damage to a certain pathway in the sympathetic nervous system. The sympathetic nervous system regulates heart rate, pupil size, perspiration, blood pressure and other functions that enable you to respond quickly to changes in your environment.

The nerve pathway affected in Horner syndrome is divided into three groups of nerve cells (neurons).

First-order neurons

This neuron pathway leads from the hypothalamus at the base of the brain, passes through the brainstem and extends into the upper portion of the spinal cord. Problems in this region that can disrupt nerve function related to Horner syndrome include:

  • Stroke
  • Tumor
  • Diseases that cause the loss of the protective sheath on neurons (myelin)
  • Neck trauma
  • Cyst or cavity in the spinal column (syringomyelia)

Second-order neurons

This neuron path extends from the spinal column, across the upper part of the chest and into the side of the neck. Causes related to nerve damage in this region may include:

  • Lung cancer
  • Tumor of the myelin sheath (schwannoma)
  • Damage to the main blood vessel leading from the heart (aorta)
  • Surgery in the chest cavity
  • Traumatic injury

Third-order neurons

This neuron path extends along the side of the neck and leads to the facial skin and muscles of the iris and eyelids. Nerve damage in this region may be associated with the following:

  • Damage to the carotid artery along the side of the neck
  • Damage to the jugular vein along the side of the neck
  • Tumor or infection near the base of the skull
  • Migraines
  • Cluster headaches, a disorder that results in cylical patterns of severe headaches

Causes in children

The most common causes of Horner syndrome in children include:

  • Injury to the neck or shoulders during delivery
  • Defect of the aorta present at birth
  • Tumor of the hormonal and nervous systems (neuroblastoma)

Unknown causes

In some cases the cause of Horner syndrome cannot be identified. This is known as idiopathic Horner syndrome.

Risk factors

What increases my risk for Horner syndrome?

Please consult your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is Horner syndrome diagnosed?

In addition to a general medical examination, your doctor will conduct tests to judge the nature of your symptoms and identify a possible cause.

Tests to confirm Horner syndrome

Your doctor may be able to diagnose Horner syndrome based on your history and his or her assessment of your symptoms.

Your doctor, often an ophthalmologist, may also confirm a diagnosis by putting a drop in both eyes — either a drop that will dilate the pupil of a healthy eye or a drop that will constrict the pupil in a healthy eye. By comparing the reactions in the healthy eye with that of the suspect eye, your doctor can determine whether nerve damage is the cause of problems in the suspect eye.

Tests to identify the site of nerve damage

The prominence or nature of certain symptoms may help your doctor narrow the search for the cause of Horner syndrome. Your doctor may also conduct additional tests or order imaging tests to locate the lesion or abnormality disrupting the nerve pathway.

Your doctor may administer a type of eyedrop that will cause significant dilation of the healthy eye and little dilation of the affected eye if Horner syndrome is caused by a third-order neuron abnormality — a disruption somewhere in the neck or above.

Your doctor may order one or more of the following imaging tests to locate the site of a probable abnormality causing Horner syndrome:

  • Magnetic resonance imaging (MRI), a technology that uses radio waves and a magnetic field to produce detailed images
  • Computerized tomography (CT), a specialized X-ray technology
  • X-ray imaging

For children with Horner syndrome, a doctor may order blood and urine tests that are used to diagnose a tumor of the hormonal and nervous systems (neuroblastoma).

How is Horner syndrome treated?

There are no treatments specifically for Horner syndrome. The best way to help your symptoms is to treat the health problem that caused them.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Horner syndrome?

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: October 19, 2017 | Last Modified: October 19, 2017

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