MayoClinic.com reprints
This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints link below.
· Order reprints of this article now.
Horner syndrome
By Mayo Clinic staffMayo Clinic Health Manager
Get free personalized health guidance for you and your family.
Get Started
About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Definition
Horner syndrome is a rare disorder that occurs when the nerves that travel from your brain to your eyes and face are damaged.
Horner syndrome typically affects only one side of your face. Hallmark findings of Horner syndrome include a drooping eyelid, decreased eye pupil size and decreased sweating on the affected side of your face.
Horner syndrome isn't a disease itself. Rather, it's a sign of another medical problem — such as a stroke, tumor or spinal cord injury — that damages the nerves to your face. In some cases, however, no underlying cause can be found.
There's no specific treatment for Horner syndrome. Instead, treatment is directed at the underlying cause, when possible.
Symptoms
Signs and symptoms of Horner syndrome usually occur on one side of your face, and typically include:
- Drooping of your upper eyelid (ptosis) and slight elevation of the lower lid
- Decreased pupil size in your affected eye
- Decreased or absent sweating on the affected side of your face (anhidrosis)
Rarely, a baby may be born with Horner syndrome. In these cases, the iris in the affected eye may be lighter in color than the other eye.
When to see a doctor
If you notice any signs or symptoms associated with Horner syndrome, see your doctor.
Causes
Horner syndrome is caused by damage to the sympathetic nerves of your face and eyes. Sympathetic nerves control your body's circulation and perspiration.
Sympathetic nerves in your face don't pass directly from your brain to your face. Instead, they start in an area of your brain known as the hypothalamus, travel through the brainstem and then down your spinal cord to enter your chest. From your chest, they go back up your neck, next to the main arteries that deliver blood to your head (carotid arteries), into your skull and then to your eyes. If the nerves are injured at any point along this route, Horner syndrome can result. Signs and symptoms of Horner syndrome usually occur on only one the side of your face because separate sympathetic nerves control each side.
Conditions that can damage the sympathetic nerve fibers and cause Horner syndrome include:
- Stroke
- Tumor
- Spinal cord injury
- Syringomyelia — a condition in which a fluid-filled cyst (syrinx) develops within your spinal cord
- A tear in the inner lining of one of your carotid arteries (carotid artery dissection)
- Cluster or migraine headaches
- An injury to a baby during birth
Although Horner syndrome may be a sign of one of these conditions, in some situations, a specific cause can't be found. This is known as idiopathic Horner syndrome.
Preparing for your appointment
You're likely to start by first seeing your family doctor. However, in some cases when you call to set up an appointment, you may be referred immediately to a neurologist — a doctor who specializes in nervous system disorders, including diseases of the brain, spinal cord, nerves and muscles.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared for your appointment.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses, recent life changes and any past injuries.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For Horner syndrome some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on later. Be as specific as you can when answering. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
What you can do in the meantime
Avoid doing anything that seems to worsen your symptoms.
Tests and diagnosis
To diagnose Horner syndrome, your doctor will start by asking about your medical history and doing a complete physical examination.
Pupil dilation test
If you have Horner syndrome, your pupil will open (dilate) slower than normal. Your doctor can evaluate this by placing drops of medication in your eye that force your pupil to dilate. The way the pupil responds to the eye drops will help confirm or deny a diagnosis of Horner syndrome.
Follow-up tests
A physical exam and pupil dilation test can confirm a diagnosis of Horner syndrome. However, to find the underlying cause of Horner syndrome you'll likely need other tests. Depending on your situation, these may include:
- Magnetic resonance imaging (MRI) of your head, neck and chest to identify tumors, signs of stroke, carotid artery dissection and other conditions that may affect the sympathetic nerves of your face.
- Blood tests or urine tests to detect substances produced by cancers.
Treatments and drugs
There's no specific treatment for Horner syndrome. Treatment depends on the cause. Often, Horner syndrome disappears when an underlying medical condition is effectively treated.
If you're having difficulty seeing out of the affected eye, your doctor may recommend that you be monitored by an eye doctor (ophthalmologist).
- Kedar S, et al. Horner's syndrome. http://www.uptodate.com/home/index.html. Accessed Feb. 4, 2009.
- Riordan-Eva P, et al. Neuro-ophthalmology. In: Riordan-Eva P, et al. Vaughan & Asbury's General Ophthalmology. 17th ed. New York, N.Y.: McGraw-Hill; 2004. http://www.accessmedicine.com/content.aspx?aID=3091826&searchStr=horner's+syndrome. Accessed Feb. 4, 2009.
- Ropper AH, et al. Disorders of ocular movement and pupillary function. In: Ropper AH, et al. Adams and Victor's Principles of Neurology. 8th ed. New York, N.Y.: McGraw-Hill; 2005. http://www.accessmedicine.com/content.aspx?aID=969125&searchStr=horner's+syndrome. Accessed Feb. 4, 2009.
- Birinyi F, et al. Ophthalmologic conditions. In: Knoop KJ, et al. Atlas of Emergency Medicine. 2nd ed. New York, N.Y.: McGraw-Hill; 2002. http://www.accessmedicine.com/content.aspx?aID=787476&searchStr=horner's+syndrome. Accessed Feb. 4, 2009.
- Mahoney NR, et al. Pediatric Horner syndrome: Etiologies and roles of imaging and urine studies to detect neuroblastoma and other responsible mass lesions. American Journal of Ophthalmology. 2006;142:651.
- Braverman RS. Eye. In: Hey WW, et al. Current Diagnosis & Treatment: Pediatrics, 19th ed. New York, N.Y.: McGraw-Hill; 2009. http://www.accessmedicine.com/content.aspx?aID=3401185&searchStr=horner's+syndrome. Accessed Feb. 4, 2009.
