Horner syndrome

Horner syndrome classically presents as an ipsilateral enophthalmosblepharoptosis, pupillary miosis and facial anhydrosis due to disruption at some point of the oculosympathetic pathway. The ptosis is due to interruption of the sympathetic control of the superior tarsal muscle a small smooth muscle fiber muscle intimately associated with the undersurface of levator palpebrae superioris muscle. This muscle inserts into the tarsal plate of the upper eyelid and controls elevation and retraction.

Pathology

Horner syndrome can be anatomically classified into three types, depending on where the pathology affects the sympathetic pathway 1. Interestingly, postganglionic lesions do not tend to present with anhydrosis, as opposed to central or preganglionic lesions. 

  • central: involves the first order neuron that starts in the hypothalamus and descends down the brainstem to the level between C8 and T2
  • preganglionic: involves the second order neuron that passes from the brainstem to the superior cervical ganglion in the neck
  • postganglionic: involves the third order neuron that ascends along the internal carotid artery to enter the cavernous sinus, where it joins the ophthalmic division of the trigeminal nerve
Etiology

There is an extremely long list of causes. The main ones include 3:

Central causes

Pre-ganglionic causes
Post-ganglionic causes
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Article information

rID: 7463
Synonyms or Alternate Spellings:
  • Horner's syndrome
  • Oculosympathetic palsy

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Cases and figures

  • Figure 1: clinical photograph - Horner syndrome
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  • Case 1: ICA dissection (left)
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  • Case 2: supraclavicular mass (left)
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