Horner Syndrome
Overview
Horner syndrome is a medical problem that causes changes on one side of the face and eye. It happens when a nerve pathway, which carries signals from the brain to the head and neck, gets interrupted or damaged. This disruption prevents the normal flow of signals, leading to the symptoms associated with the condition.
Symptoms
Horner syndrome typically affects just one side of the face. This means the symptoms are usually noticeable on one eye and one side of the head. Here are some of the common signs:
- Smaller pupil (miosis): The pupil of the affected eye is often smaller than the pupil of the other eye.
- Different-sized pupils (anisocoria): The most noticeable symptom is often that the pupils are different sizes. One pupil is noticeably smaller than the other.
- Pupil doesn't react well to dim light: In low light, the affected pupil doesn't open (dilate) as much or as quickly as the other pupil. This is because the nerves controlling pupil size are affected.
- Drooping eyelid (ptosis): The upper eyelid on the affected side may droop lower than the other.
- Slightly raised lower eyelid (sometimes called upside-down ptosis): Sometimes, there's a slight raising or bulging of the lower eyelid on the affected side. It's not always present.
- Affected eye may appear sunken: The affected eye might look a bit sunken in.
- Reduced or no sweating on the affected side (anhidrosis): This is a reduction or absence of sweating on the face and sometimes the neck on the affected side of the face. This can be subtle and easily missed.
Important Note: The signs of drooping eyelid (ptosis) and reduced sweating (anhidrosis) can be very subtle. It might be hard to notice these differences at first, even for a doctor.
When to see a doctor
Horner syndrome can have several causes, ranging from minor to more serious. A quick and correct diagnosis is crucial.
Seek immediate medical attention if you notice signs of Horner syndrome suddenly, or if they appear after an injury, or if they come with other symptoms. These additional symptoms could include:
- Trouble seeing clearly
- Feeling dizzy or lightheaded
- Slurred or unclear speech
- Difficulty moving or walking
- Weakness in your muscles or trouble controlling them
- A very bad, sudden headache or neck pain.
These extra symptoms are important because they might suggest a more serious underlying problem that needs immediate medical attention.
Causes
Horner syndrome happens when a part of your nervous system, called the sympathetic nervous system, gets damaged. This system helps your body react quickly to things around you. It controls important functions like how fast your heart beats, how big your pupils are, how much you sweat, and your blood pressure.
The nerves involved in Horner syndrome are grouped into three different types of nerve cells, or neurons.
Diagnosis
To find out what's causing your symptoms, your doctor will likely do a physical exam and some tests.
Your doctor might be able to diagnose Horner syndrome just by talking to you about your symptoms and checking them out.
An eye doctor (ophthalmologist) can also help confirm the diagnosis. They might put a special eye drop in both eyes. One type of drop will make one eye's pupil bigger, and another type will make it smaller. By comparing how the healthy eye reacts to the drop with how the other eye reacts, the doctor can see if nerve damage is the problem.
The specific symptoms you have can help your doctor figure out what's causing Horner syndrome. They might do more tests or imaging scans to pinpoint the exact area where the nerves are being affected.
If Horner syndrome is due to a problem in the nerves in the neck or head, your doctor might use a special eye drop that widens one eye's pupil a lot more than the other.
To find the source of the problem, your doctor might order some imaging tests. These tests can create detailed pictures of your body. Examples include:
- MRI (Magnetic Resonance Imaging): This uses radio waves and magnets to create detailed pictures of the inside of your body, showing soft tissues like the brain and spinal cord.
- MRA (Magnetic Resonance Angiography): This type of MRI focuses on blood vessels to see if there are any blockages or other issues.
- Chest X-ray: This is a quick way to look at your lungs and other structures in your chest.
- CT (Computed Tomography): This uses X-rays to create detailed images of your body, useful for looking at bones and other structures.
Treatment
Horner syndrome doesn't have a specific cure. Usually, if the medical problem causing it is taken care of, the Horner syndrome symptoms go away. In other words, treating the reason behind Horner syndrome often resolves the syndrome itself.
Preparing for your appointment
To get help for most non-emergency eye or nervous system problems, you usually start with a general doctor, or an eye doctor (ophthalmologist). Sometimes, you might be referred to a doctor specializing in the nervous system (neurologist), or a doctor who knows about both the nervous system and eye problems (neuro-ophthalmologist).
Getting Ready for Your Appointment:
Before your appointment, make a list of important information. This will help you remember things during the visit.
It's a good idea to bring a friend or family member with you. They can help you remember what the doctor says.
Questions to Ask Your Doctor:
Prepare some questions to ask your doctor. This shows you're taking an active role in your care. Here are some examples:
- What is the most likely cause of my symptoms?
- What are other possible causes?
- What tests do I need?
- Is this problem likely to be short-term or long-term?
- What's the best treatment plan?
- Will I need more checkups or tests in the future?
Information to Share with Your Doctor:
Your doctor will want to know about your symptoms and health history. Be prepared to share:
- Your symptoms: Describe any changes you've noticed, even small ones that bother you.
- Personal information: Tell your doctor about any past illnesses, injuries, or stresses in your life. This is important context.
- All medications, vitamins, and supplements: Include the doses.
- Important Dates: When did your symptoms first start? Have they gotten worse over time?
- Medical History: Tell your doctor about any history of cancer, injuries, or problems like migraines.
- Any Pain: Mention any pain in your head, neck, shoulders, or arms.
Visual Aids (Optional):
If possible, bring recent photos of your eye(s), taken before your symptoms started. These pictures can help your doctor see how your eye has changed.
What to Expect During Your Appointment:
Your doctor will likely ask you questions about your symptoms and take a general physical exam. They might ask about things like:
- Your Symptoms: (e.g., vision changes, pain, numbness)
- Important Medical History: (e.g., past illnesses, injuries, family history of eye or nervous system problems)
- Medications and Supplements:
- When Symptoms Started: (e.g., date, time)
- Changes in Symptoms: (e.g., have they gotten worse, better, stayed the same?)
- Injuries or Trauma: (e.g., recent falls, bumps, accidents)
Disclaimer: August is a health information platform and its responses don't constitute medical advise. Always consult with a licenced medical professional near you before making any changes.