Horner's syndrome

Horner's syndrome Symptoms, Cause and Treatment

This collection of signs - of unilateral pupillary constriction with slight relative ptosis and enophthalmos - indicates a lesion of the sympathetic pathway on the same side. The conjunctival vessels are slightly injected. There is loss of sweating of the same side of the face or body; the extent depending upon the level of the lesion:

1. Central lesions affect sweating over the entire half of the head, arm and upper trunk.
2. Neck lesions proximal to the superior cervical ganglion cause diminished facial sweating.
3. Lesions distal to the superior cervical ganglion do not affect sweating at all.

Pharmacological tests help to indicate the level of the lesion. For example, a lesion distal to the superior cervical ganglion causes denervation hypersensitivity of the pupil, which dilates when 1:1000 adrenaline (epinephrine) is instilled. This dose has little effect on the normal pupil or a Horner's pupil from a proximal lesion. In clinical practice the test is of limited value.

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