Horner Syndrome
Basics
Description
Unilateral sympathetic denervation of the eye produces signs of Horner syndrome:Description
- 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
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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Citation
Schaider, Jeffrey J., et al., editors. "Horner Syndrome." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner_Syndrome.
Horner Syndrome. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner_Syndrome. Accessed December 3, 2024.
Horner Syndrome. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner_Syndrome
Horner Syndrome [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307097/all/Horner_Syndrome.
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