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into the synaptic cleft and resulting in robust mydriasis of the affected pupil. If the lesion itself is of the third order neuron, then the amphetamine will have no effect and the pupil remains constricted. There is no pharmacological test to differentiate between a first and second order neuron lesion.
641:
test: This test helps to localize the cause of the miosis. If the third order neuron (the last of three neurons in the pathway which ultimately discharges norepinephrine into the synaptic cleft) is intact, then the amphetamine causes neurotransmitter vesicle release, thus releasing norepinephrine
334:
which produces ptosis. It reduces sweat secretion in the face. Patients may have apparent enophthalmos (affected eye looks to be slightly sunken in) but this is not always the case. The ptosis from inactivation of the superior tarsal muscle causes the eye to appear sunken in, but when actually
400:(caused by medical treatment). In rare cases, Horner's syndrome may be the result of repeated, minor head trauma, such as being hit with a soccer ball. Although most causes are relatively benign, Horner's syndrome may reflect serious disease in the neck or chest (such as a
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to both eyes and observe the increased mydriatic effect (due to hypersensitivity) on the affected side of Horner syndrome (the opposite effect to what the cocaine test would produce in the presence of Horner's).
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occurs and the examiner is unsure whether the abnormal pupil is the constricted or dilated one, if a one-sided ptosis is present then the abnormally sized pupil can be presumed to be on the side of the ptosis.
657:. In the former, the ptosis occurs with a constricted pupil (due to a loss of sympathetics to the eye), whereas in the latter, the ptosis occurs with a dilated pupil (due to a loss of innervation to the
591:
If patients have impaired sweating above the waist affecting only one side of the body, and they do not have clinically apparent Horner's syndrome, then their lesions are just below the
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Partial Horner's syndrome: In case of a third-neuron disorder, anhidrosis is limited to the middle part of the forehead or can be absent, resulting in a partial Horner's syndrome.
707:
is also eponymized with the condition (Claude
Bernard–Horner syndrome, abbreviated CBH). In France, Francois Pourfour du Petit is also credited with describing this syndrome.
665:) lesion, this ptosis is much more severe, occasionally occluding the whole eye. The ptosis of Horner syndrome can be quite mild or barely noticeable (partial ptosis).
1386:
1461:
1018:
Lee JH, Lee HK, Lee DH, Choi CG, Kim SJ, Suh DC (January 2007). "Neuroimaging strategies for three types of Horner syndrome with emphasis on anatomic location".
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of a normal pupil from retention of norepinephrine in the synapse. However, in Horner's syndrome the lack of norepinephrine in the synaptic cleft causes
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on the affected side of the face due to dilation of blood vessels under the skin. The pupil's light reflex is maintained as this is controlled via the
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failure. A more recently introduced approach that is more dependable and obviates the difficulties in obtaining cocaine is to apply the alpha-agonist
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who first described the syndrome in 1869. Several others had previously described cases, but "Horner's syndrome" is most prevalent. In
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measured, enophthalmos is not present. The phenomenon of enophthalmos is seen in Horner's syndrome in cats, rats, and dogs.
79:
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661:). In a clinical setting, these two ptoses are fairly easy to distinguish. In addition to the blown pupil in a CNIII (
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side of the symptoms. The following are examples of conditions that cause the clinical appearance of Horner's syndrome:
316:
unilateral straight hair (in congenital Horner's syndrome); the hair on the affected side may be straight in some cases.
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810:
Ropper AH, Brown RH (2005). "14: disorders of ocular movement and pupillary function". In Ropper AH, Brown RH (eds.).
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Scheme showing sympathetic and parasympathetic innervation of the pupil and sites of a lesion in Horner's syndrome.
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Signs that are found in people with Horner's syndrome on the affected side of the face include the following:
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Left-sided Horner's syndrome in a cat as a result of trauma, demonstrating miosis in left pupil.
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lesions (e.g. compression of the sympathetic chain by a lung tumor) that releases acetylcholine.
1128:
Neuro-ophthalmology: Handbook of
Clinical Neurology (Series Editors: Aminoff, Boller and Swaab)
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849:"Horner's syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program"
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Interruption of sympathetic pathways leads to several implications. It inactivates the
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Three tests are useful in confirming the presence and severity of Horner syndrome:
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is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a
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In veterinary medicine, signs can include partial closure of the third eyelid, or
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may be required to identify the location of the problem and the underlying cause.
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Horner's syndrome is usually acquired as a result of disease, but may also be
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Causes can be divided according to the presence and location of anhidrosis:
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lesions at the level of the internal carotid artery (e.g. a tumor in the
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240:, and from there ascend to the neck and face. The nerves are part of the
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541:, such as cervical plexus block, stellate ganglion or interscalene block
248:(or involuntary) nervous system. Once the syndrome has been recognized,
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caused by Horner's syndrome from the ptosis caused by a lesion to the
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814:(8th ed.). New York: McGraw-Hill Professional. pp. 222–45.
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404:(tumor in the apex of the lung) or thyrocervical venous dilatation).
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activity. The site of lesion to the sympathetic outflow is on the
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723:. The cause of about a third of cases in children is unknown.
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First-order neuron disorder: Central lesions that involve the
29:
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or a carotid artery dissection) that releases norepinephrine.
193:, is a combination of symptoms that arises when a group of
928:
Laing C, Thomas DJ, Mathias CJ, Unwin RJ (October 2000).
486:- base of neck, usually blunt trauma, sometimes surgery.
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Facial disorder due to damage of the sympathetic nerves
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Bernard-Horner syndrome (BH), oculosympathetic palsy
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1395:
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757:"Horner syndrome: MedlinePlus Medical Encyclopedia"
514:An episode of Horner's syndrome may occur during a
232:The nerves of the sympathetic trunk arise from the
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60:. Unsourced material may be challenged and removed.
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396:(inborn, associated with heterochromatic iris) or
349:In children, Horner's syndrome sometimes leads to
205:of the sympathetic trunk. It is characterized by
1387:Congenital insensitivity to pain with anhidrosis
879:"Enophthalmos is not present in Horner syndrome"
330:and thereby produces miosis. It inactivates the
292:inability to completely close or open the eyelid
1089:Logan, Carolynn M.; Rice, M. Katherine (1987).
1053:Horner JF (1869). "Über eine Form von Ptosis".
991:, Treasure Island (FL): StatPearls Publishing,
619:eyedrops block the reuptake of post-ganglionic
566:(e.g. transection of the cervical spinal cord).
930:"Headache, hypertension and Horner's syndrome"
1315:
715:The most common causes in young children are
8:
1093:Logan's Medical and Scientific Abbreviations
411:Central (anhidrosis of face, arm and trunk)
1377:Hereditary sensory and autonomic neuropathy
1322:
1308:
1300:
1153:
983:Koka, Kirthi; Patel, Bhupendra C. (2023),
812:Adams and Victor's Principles of Neurology
550:Horner syndrome is due to a deficiency of
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1410:Postural orthostatic tachycardia syndrome
1097:. J. B. Lippincott and Company. pp.
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904:
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120:Learn how and when to remove this message
934:Journal of the Royal Society of Medicine
805:
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1462:Syndromes affecting the nervous system
1020:AJR. American Journal of Roentgenology
511:- combination termed Horton's headache
289:(sinking of the eyeball into the face)
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221:(decreased sweating), with apparent
58:adding citations to reliable sources
1452:Peripheral nervous system disorders
649:It is important to distinguish the
1125:Kennard C, Leigh RJ (2011-06-28).
313:, depending on the site of lesion.
217:(a weak, droopy eyelid), apparent
25:
518:attack and be relieved afterwards
322:(in congenital Horner's syndrome)
34:
45:needs additional citations for
569:Second-order neuron disorder:
344:parasympathetic nervous system
271:(drooping of the upper eyelid)
1:
576:Third-order neuron disorder:
450:traction on stellate ganglion
896:10.1371/journal.pmed.0020120
719:and a type of cancer called
160:Left-sided Horner's syndrome
1467:Syndromes affecting the eye
283:(constriction of the pupil)
252:and response to particular
1493:
946:10.1177/014107680009301010
780:Reference, Genetics Home.
595:in the sympathetic chain.
522:Cavernous sinus thrombosis
435:Lateral medullary syndrome
242:sympathetic nervous system
1131:. Elsevier. p. 452.
853:rarediseases.info.nih.gov
471:of the superior fissure (
159:
150:
1332:autonomic nervous system
1055:Klin Monatsbl Augenheilk
496:Thoracic aortic aneurysm
191:oculosympathetic paresis
1431:Multiple system atrophy
1405:Orthostatic hypotension
1397:Orthostatic intolerance
877:Daroff R (April 2005).
786:Genetics Home Reference
686:Johann Friedrich Horner
564:hypothalamospinal tract
1361:Pure autonomic failure
608:
469:Bronchogenic carcinoma
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332:superior tarsal muscle
1382:Familial dysautonomia
1351:Autonomic dysreflexia
1288:Horner's syndrome
606:
489:As a complication of
444:(anhidrosis of face)
387:
1356:Autonomic neuropathy
527:Middle ear infection
374:nictitating membrane
357:pigmentation of the
320:heterochromia iridum
277:(decreased sweating)
244:, a division of the
54:improve this article
1477:Eponyms in medicine
1032:10.2214/AJR.05.1588
985:"Ptosis Correction"
615:Cocaine drop test:
361:in the superficial
338:Sometimes there is
69:"Horner's syndrome"
1249:External resources
738:Harlequin syndrome
659:sphincter pupillae
609:
420:Multiple sclerosis
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303:ciliospinal reflex
260:Signs and symptoms
1439:
1438:
1426:Horner's syndrome
1297:
1296:
782:"Horner syndrome"
645:Dilation lag test
623:resulting in the
593:stellate ganglion
491:tube thoracostomy
479:Klumpke paralysis
475:) on apex of lung
454:Thyroid carcinoma
199:sympathetic trunk
187:Horner's syndrome
184:
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138:Horner's syndrome
132:Medical condition
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16:(Redirected from
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681:The syndrome is
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509:Cluster headache
505:(no anhidrosis)
189:, also known as
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295:facial flushing
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209:(a constricted
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43:This article
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1457:Eye diseases
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861:. Retrieved
857:the original
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789:. Retrieved
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764:. Retrieved
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717:birth trauma
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539:Nerve blocks
448:Cervical rib
430:Brain tumors
425:Encephalitis
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287:Enophthalmos
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223:enophthalmos
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52:Please help
47:verification
44:
1472:Human pupil
1258:MedlinePlus
889:(4): e120.
683:named after
556:ipsilateral
552:sympathetic
359:melanocytes
311:conjunctiva
234:spinal cord
213:), partial
143:Other names
1446:Categories
1370:Hereditary
1283:Patient UK
1223:DiseasesDB
1002:2024-01-04
989:StatPearls
863:2019-10-15
791:2019-05-06
766:2019-05-06
744:References
733:Anisocoria
670:anisocoria
398:iatrogenic
394:congenital
275:anhidrosis
219:anhidrosis
80:newspapers
1269:eMedicine
1234:SNOMED CT
1073:synd/1056
639:Paredrine
629:mydriatic
599:Diagnosis
308:bloodshot
298:headaches
254:eye drops
246:autonomic
171:Neurology
166:Specialty
1274:med/1029
1239:12731000
1061:: 193–8.
1040:17179330
997:30969650
964:11064693
915:15839747
727:See also
711:Children
625:dilation
516:migraine
340:flushing
301:loss of
1339:General
1277:oph/336
1217:D006732
955:1298129
906:1087222
677:History
617:Cocaine
365:of the
355:melanin
236:in the
227:eyeball
225:(inset
94:scholar
18:Horners
1263:000708
1206:143000
1135:
1105:
1038:
995:
962:
952:
913:
903:
818:
697:France
688:, the
651:ptosis
484:Trauma
464:Goiter
380:Causes
363:stroma
281:miosis
269:ptosis
215:ptosis
207:miosis
203:lesion
195:nerves
173:
96:
89:
82:
75:
67:
1419:Other
1195:337.9
1180:G90.2
701:Italy
690:Swiss
668:When
238:chest
211:pupil
101:JSTOR
87:books
1228:6014
1212:MeSH
1201:OMIM
1190:9-CM
1133:ISBN
1103:ISBN
1036:PMID
993:PMID
960:PMID
911:PMID
816:ISBN
699:and
367:iris
73:news
1186:ICD
1171:ICD
1076:at
1028:doi
1024:188
950:PMC
942:doi
901:PMC
891:doi
229:).
56:by
1448::
1286::
1272::
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1237::
1226::
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987:,
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703:,
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346:.
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1030::
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893::
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98:·
91:·
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