Horner's syndrome

(Bernard-Horner syndrome)
(oculosympathetic palsy)
Horner's syndromeorHorner syndromeis a
clinicalsyndrome caused by damage to the
sympathetic nervous system.

History
1869- Johann Friedrich Horner
theSwissophthalmologistwho first
described.
Claude Bernardis also eponymised
with the condition

Pathophysiology

The nervous system in the body does not consist of straight

lines to and from the brain. In respect to the eye, the
sympathetic nerves travels from the brain down the spinal
column to the chest area and back up.

First neuron pathway, starts at the brain and travels

down the spinal cord and into the chest.

Second neuron pathway continues from the chest cavity,

over the lungs and up the carotid artery in the neck.

Third neuron pathway goes from the carotid artery and

jugular vein through the middle ear and then into the eye.

Upon entering the eye the nerve pathways split, one goes to
the pupil and one goes to the muscles of the eyelid.

Horner's syndrome may occur as a result of lesions found

along the course of the nerve's route from the brain to the
eye.

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Etiology
First Neuron Horner's Syndrome (Central lesions)

(1)Ischemic posterioinferior cerebellar

artery(Wallenberg 's syndrome)
(2)Brain tumors

Second Neuron Horner's Syndrome (Preganglioniclesions)

(1) lung cancer ( (Pancoast tumor ) on apex of lung)

(2) thoracic tumors

(3) thyroid enlargement

(4) osteoarthritis of the neck

(5) neck trauma caused by injury
Third Neuron Horner's Syndrome (Postganglionic
lesions) :(1) Cluster headache
(2) Middle ear infection
(3) Cervical ribtraction on stellate ganglion
(4) skull fracture
(5 cavernous sinus tumor

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Clinical features
Ptosis(which is drooping of the upper
eyelid from loss of sympathetic
innervation to thesuperior tarsal muscle)
miosis(constricted pupil)
anhidrosis(decreased sweating on the
affected side of the face)
dilationlag (slow response of the pupil to
light)
Enophthalmos(the impression that the
eye is sunk in)
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 bloodshotconjunctiva
flushing of the face is on the affected side
of the face due to dilation of blood
vessels under the skin.
Heterochromia difference in eye color
between the two eyes due to lack of
sympathetic stimulation of
themelanocytesin iris. (iris may be of a
different color).
Swelling of the lower eyelid
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DIAGNOSIS
Cocaine drop test:-Cocaine cause
dilated pupil.
In Horners syndrome pupil fails to dilate
lack of norepinephrine
Paredrinetest:- helps to locate the
lesion in 3rd neuronal
pathway.Amphetamine causes robust
mydriasis. But in horners syndrome no
effect.
Dilation lag test
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Treatment
Treatment depends on the location
and cause of the lesion
surgical removal of a tumor
tumor is malignant:--radiation
andchemotherapy

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