Horner's syndrome

Horner's syndrome

Horner's syndrome is a group of symptoms caused by damage to the nerve pathways from the brain to the face. This syndrome can occur due to other diseases or even the cause is unknown.

Horner's syndrome can be caused by medical conditions, such as stroke , spinal cord injury, or tumors. However, in some cases, the cause of this disease is not known for sure.

Horner's syndrome is marked by the shrinking of one of the pupils of the eye and drooping of one of the eyelids ( ptosis ). Although not dangerous, this condition can be a sign of a serious health disorder.

Causes of Horner's Syndrome

Horner's syndrome is caused by damage to the sympathetic nervous system network that connects from the brain to the face and eyes. This nervous system plays a role in regulating heart rate, eye pupil size, blood pressure, and sweat output.

Nerve cells (neurons) affected by Horner's syndrome are divided into three types, namely:

Level I neurons

This neuron line extends from the hypothalamus, brain stem, to the upper spinal cord. This type of nerve cell damage can be caused by:

  • Stroke
  • Tumors
  • Neck injury
  • A disease that causes the loss of the protective layer of nerve cells
  • A cyst or cavity in the spine

Level II neurons

This neuron line extends from the spine, the upper chest, and the side of the neck. Medical conditions that can cause nerve damage in this part are:

  • Lung cancer
  • Tumors in the protective layer of nerves
  • Damage to the main blood vessel from the heart (aorta)
  • Surgery in the chest cavity
  • Injury due to collision or accident

Level III neurons

This neuron line extends from the side of the neck leading to the skin of the face, as well as the muscles of the eyelids and iris. Damage to nerve cells of this type can occur as a result of:

  • Damage to arteries along the neck
  • Damage to blood vessels along the neck
  • Tumor or infection at the base of the skull
  • Cluster headache
  • Migraine

In children, common causes of Horner's syndrome are injuries to the neck and shoulders at birth, abnormalities of the aorta at birth, or tumors of the nervous and hormonal systems.

In some cases, the cause of Horner's syndrome is unknown. This condition is called idiopathic Horner's syndrome.

Symptoms of Horner's Syndrome

Symptoms of Horner's syndrome generally only affect one side of the sufferer's face. Some of the symptoms and signs of Horner's syndrome are:

  • The size of the two eye pupils that look different , one of them is very small ( miosis )
  • Drooping upper eyelids (ptosis)
  • One of the lower eyelids is slightly raised ( inverse ptosis )
  • Pupils are delayed or do not dilate when in a room with poor light conditions
  • The face sweats little or not at all
  • The eyes look dull and red

Symptoms of Horner's syndrome in adults and children are generally similar. It's just that adults who suffer from Horner's syndrome usually feel pain or  headaches . While in patients under 2 years of age, there are some additional symptoms, namely:

  • The color of the iris is different ( heterochromia ) or paler on one side of the eye
  • The part of the face affected by Horner's syndrome does not flush ( flushing ) when exposed to the sun, doing physical exercise, or when emotional.

When should you go to the doctor?

Immediately check with a doctor if you experience the signs and symptoms of Horner's syndrome as mentioned. Examination should also be done immediately if symptoms appear after an injury or accident, or accompanied by:

  • Turn
  • Visual impairment
  • Weakness or loss of muscle control
  • Headache or neck pain that feels great and occurs suddenly

Diagnosis of Horner's Syndrome

Horner's syndrome is difficult to diagnose, because the symptoms are similar to the symptoms of other diseases. To ensure this, the doctor will ask about the history of illness, injury, or certain operations.

Doctors can also suspect that a patient suffers from Horner's syndrome if on physical examination complaints are found in the form of:

  • Asymmetric pupil size
  • Ptosis on one of the eyelids
  • Sweat does not appear on one side of the face

To be more sure of Horner's syndrome, the doctor will perform further examinations, such as:

Eye examination

The doctor will check the pupil response of the patient's eye, by instilling eye drops containing apraclonidine to dilate the pupil. If the pupil does not dilate, it can be confirmed that the patient has Horner's syndrome.


Scanning with USG, X-ray,  CT scan , or MRI will be performed on patients with structural abnormalities, wounds, or tumors on the brain.

Treatment of Horner's Syndrome

The treatment of Horner's syndrome is to overcome the causes, among others:

  • Surgery, radiotherapy, or chemotherapy to treat cancer
  • Antiplatelet drugs and angioplasty to overcome arterial damage in the neck
  • Blood thinners to treat stroke
  • Antibiotics or antivirals to treat infections
  • Anti-inflammatory drugs to treat multiple sclerosis

Specific treatment is generally not required in Horner's syndrome which causes only mild ptosis.

Complications of Horner's Syndrome

A number of complications that can be experienced by people with Horner's syndrome are:

  • Dizziness and balance disorders
  • Visual impairment
  • Severe and sudden neck pain or headache
  • Muscle weakness

Prevention of Horner's Syndrome

The way to prevent Horner's syndrome is to prevent the underlying cause. For example, undergoing genetic counseling when planning a pregnancy can prevent Horner's syndrome due to a hereditary disease.

In addition, Horner's syndrome can also be caused by injury to the brain or neck. To prevent it, efforts that can be made include:

  • Always wear a helmet or seat belt when driving
  • Be careful when driving or walking on the road
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