Horner Syndrome

Description

Horner syndrome is associated with an interruption to the sympathetic nerve supply of the eye. It is characterized by the classic triad of miosis, partial ptosis, and anhidrosis +/- enophthalmos

Horner Syndrome may occur secondary to:

  • Local compression of brachial plexus and sympathetic chain by superior (pulmonary) sulcus tumors.(e.g. Pancoast tumor)
  • Brainstem stroke
  • Carotid artery aneurysm (dissection) or critical ischaemia
  • Trauma involving the brachial plexus
  • Neoplasm of the middle cranial fossa
Horner left ptosis miosis no flash
Horner syndrome: Triad of miosis, partial ptosis, and anhidrosis +/- enophthalmos

Horner’s syndrome is present in Wallenberg syndrome, Babinski-Nageotte syndrome, Cestan-Chenais syndrome, Klumpke syndrome, Villaret syndrome, and Raeder syndrome.


History of Horner Syndrome

1727 – François Pourfour du Petit (1664 – 1741)

1852Claude Bernard (1813 – 1878)

1864Silas Weir Mitchell (1829-1914)

1865Sir Jonathan Hutchinson (1828 – 1913)

1869 –  Johann Friedrich Horner (1831 – 1886) reported the findings of ptosismiosis, and enophthalmos in a 40-year-old peasant woman. He also observed increased skin temperature and dryness of the ipsilateral face.

He pharmacologically confirmed the impairment of sympathetic innervation to the eye after noting poor dilation of the affected pupil following instillation of atropine and preserved pupillary constriction to the parasympathomimetic agent calabar. [1869;7:193-198]

Frau Anna Brändli, 40 Jahre alt, eine gesund aussehende Bäuerin mittlerer Grösse… bemerkte ein allmähliges herabsinken des rechten oberen Augenlides, das sehr langsam zunahm… Das obere Lid deckt die rechte Cornea bis an den oberen Pupillarrand… Die Pupille des rechten Auges ist bedutend enger als diejenige des linken…  Nun erst erzählte uns die Patientin, dass sie rechterseits nie geschwitzt habe

Die Untersuchungen ergaben also Integrität des sensiblen Trigeminus, transitorische Lähmung des vasomotorischen Fasern im rechtseitigen Trigeminusgebiet;… (es) wundert sich Niemand, wenn ich diese… nie vollständige Ptosis als Lähmung des vom Sympathicus versorgten organischen Musc. palpebral super. ansehe.

Horner, J. 1869

Mrs Anna Brändli, 40 years old, a healthy looking Farmer of middle size… noticed a gradual sinking of her right upper eyelid, which was progressing slowly… The upper lid covered the right Cornea up to the edge of the pupil… The pupil of the right eye is notably smaller than that of the left… Now the patient told us that she did not sweat on the right side

The investigations demonstrated integrity of the sensory Trigeminus, transitory paralysis of the vasomotor fibres of the right Trigeminal territory… noone will be surprised if I attribute this incomplete Ptosis to a paralysis of the Levator Palpebrae superioris muscle, supplied organically by the sympathicus.

Horner, J. 1869


Associated Persons

Alternative names
  • Horner’s syndrome
  • Bernard-Horner syndrome (France)
  • Claude Bernard syndrome
  • Von Passow syndrome

References

Original articles

Eponymous review

  • von Passow A. Okulare Paresen im Symptomenbilde des “Status dysraphicus”, zugleich ein Beitrag zur Ätiologie der Sympathikusparese (Horner-Syndrom und Heterochromia iridis). Münchener medizinische Wochenshrift, 1934; 74: 1243-1249.
  • Durham DG. Congenital hereditary Horner’s syndrome. AMA Arch Ophthalmol. 1958 Nov;60(5):939-40.

FOAMed review and cases


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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