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Horner's Syndrome

Horner's Syndrome is a topic covered in the 5-Minute Emergency Consult.

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Unilateral sympathetic denervation of the eye produces signs of Horner's syndrome:
  • Relaxation of retracting muscles in upper and lower lids:
    • Ptosis (drooping of the lids)
  • Loss of pupillary dilator innervation:
    • Miosis (unopposed pupillary constriction)
  • Loss of sympathetic stimulation of sweat glands:
    • Anhidrosis


  • 40% unknown (in 1 large series)
  • Tumors of lung or metastases to cervical nodes:
    • May interrupt preganglionic sympathetic fibers (between thoracic sympathetic trunk and superior cervical ganglion)
  • Trauma: Penetrating neck wounds directly injure sympathetic fibers
  • Pneumothorax:
    • Tension pneumothorax may cause traction on sympathetic fibers owing to shift of mediastinal structures.
  • Infiltration or infection of cervical nodes:
    • Sarcoidosis, tuberculosis
  • Vascular disorders:
    • Migraine or cluster headaches
    • Carotid artery dissection
  • Lateral medullary infarction produces Horner's syndrome as part of the Wallenberg syndrome:
    • Presents with vertigo and ataxia, which may overshadow the Horner's syndrome.
  • Cavernous sinus thrombosis may present with some of the features of Horner's syndrome:
    • The condition typically causes headache and/or eye pain.
    • Ocular signs include ocular palsies, pain, chemosis, and proptosis.

Pediatric Considerations
  • Hereditary Horner's syndrome:
    • Blue iris (or irregular coloration) on affected side
    • Brown on unaffected side (heterochromia iridis)
  • Birth trauma:
    • May cause damage to sympathetic chain
  • New Horner's syndrome in a child should prompt workup for tumor (neuroblastoma).

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Rosen, Peter, et al., editors. "Horner's Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner's_Syndrome.
Horner's Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner's_Syndrome. Accessed April 23, 2019.
Horner's Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner's_Syndrome
Horner's Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner's_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Horner's Syndrome ID - 307097 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner's_Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -