Horner Syndrome
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Basics
Description
Unilateral sympathetic denervation of the eye produces signs of Horner 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 (unilateral lack of swelling, difficult to appreciate and may be absent)
Etiology
- 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 syndrome as part of the Wallenberg syndrome:
- Presents with vertigo and ataxia, which may overshadow the Horner syndrome
- Cavernous sinus thrombosis may present with some of the features of Horner syndrome:
- The condition typically causes headache or eye pain
- Ocular signs include ocular palsies, pain, chemosis, and proptosis
Pediatric Considerations
- Hereditary Horner 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 syndrome in a child should prompt workup for tumor (neuroblastoma)
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
Unilateral sympathetic denervation of the eye produces signs of Horner 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 (unilateral lack of swelling, difficult to appreciate and may be absent)
Etiology
- 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 syndrome as part of the Wallenberg syndrome:
- Presents with vertigo and ataxia, which may overshadow the Horner syndrome
- Cavernous sinus thrombosis may present with some of the features of Horner syndrome:
- The condition typically causes headache or eye pain
- Ocular signs include ocular palsies, pain, chemosis, and proptosis
Pediatric Considerations
- Hereditary Horner 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 syndrome in a child should prompt workup for tumor (neuroblastoma)
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