Horner’s syndrome is a pattern of syndromes affecting the face caused by neck injuries or other conditions. Symptoms include a droopy eyelid, constricted pupil, and poor sweat production. The condition can be caused by neck injuries, medications, genetic conditions, and other diseases. Tests can determine the diagnosis, and treatment depends on the underlying cause.
Horner’s syndrome is described as a pattern of syndromes affecting the face, caused by traumatic injuries to the neck, also called the cervical region of the spine, or a variety of other conditions. Johann Friedrich Horner who first described the condition in the mid 19th century called the condition. In the medical field, Horner’s syndrome can more accurately be called oculosympathetic paralysis, because damage to the cervical region causes damage to the sympathetic nervous system that regulates the face, and especially the eye.
Symptoms of Horner’s syndrome include a droopy eyelid, a constricted pupil, enophthalmos, which makes the eye appear as if it is deep in the skull or sunken, and poor sweat production. Horner’s syndrome affects only one side of the face, so there’s a big difference in appearance between the eyes. The eye on the affected side may be a different color and may be continuously bloodshot. Also, the affected side of the face may blush and appear reddish.
The causes of the condition are numerous. Neck injuries can cause damage to the sympathetic nervous system and some diseases. Sometimes medications can cause the condition. Other times, Horner’s syndrome may actually be a genetic condition, present at birth.
When the spine receives an injury, especially the neck and often from blunt trauma, Horner’s syndrome can be the result. People may also often have extremely painful headaches called cluster headaches that can cause the condition. Goiter, the extreme swelling of the thyroid gland, is a potentially causative factor, as are thyroid cancer and lung cancer affecting the bronchi. Stroke or blood clot in the aorta can result in Horner’s syndrome. In some cases, chronic middle ear infections can damage the sympathetic nervous system in the face, creating the condition, although this is rare.
Other causes include cysts in the cervix, anesthesia in the cervical area, multiple sclerosis, and neurofibratosis. Neurofibratosis is a genetic condition in which small lesions or tumors appear in various places in the spine. When they affect the cervical spine, they can cause Horner’s syndrome.
Because other conditions can mimic Horner’s syndrome, it’s important to get tests done to get the proper diagnosis. A couple of tests, such as administration of cocaine or paredrine, determine whether the affected eye dilates, causing the pupil to widen. If it doesn’t dilate properly, the condition is likely Horner’s syndrome.
Horner’s syndrome is often transient and does not necessarily require treatment. Some symptoms can be treated: Eye drops may be used if the difference in pupil size in each eye is a problem. Fortunately, the condition often resolves on its own when the underlying cause is treated. For example, antibiotics and possibly the insertion of tubes in the ears treat chronic ear infections. Sometimes underlying causes such as multiple sclerosis resist treatment and result in a semi-permanent or permanent state of Horner syndrome. Obviously with any incurable disease, or disease that can recur such as neurofibratosis, Horner’s syndrome can remain.
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