Symptom complex
Horner’s syndrome manifests itself through three defined signs of disease (symptom triad). These signs of the disease are: This eye symptomatology is accompanied by a disturbed sweating of the upper halves of the body. Horner’s syndrome is not an independent disease, but only a symptom (sign) of a disease.
However, certain nerves show certain damages. This damage can be localized at different places in the body and can be caused by a whole series of pathological processes. A congenital form of Horner’s triad is also known.
- Pupil constriction (miosis),
- Drooping of the upper eyelid (ptosis) and
- Sinking back of the eye into the eye socket (enophthalmos).
The pupil on the affected side is smaller than the one on the opposite side, the eyelid hangs down slightly and can only be lifted slightly. While the pupil normally reacts to light with a constriction, the (miotic) pupil in Horner’s syndrome reacts normally with a constriction to light, but dilates more slowly and only incompletely when darkened. Paralysis of the radial muscle cells of the iris (Musculus dilatator pupillae) is responsible for the narrowing of the pupil.
The paralysis of the upper eyelid muscle (musculus tarsalis) leads to the drooping of the upper eyelid (=ptosis). Enophthalmus of the eyes means that the eyes sink back into the orbit, while the disturbed sweat secretion is caused by damaged nerve fibers that control the sweat release in the body area. The uneven sweat secretion is clearly visible on the skin.
A paralysis of the radial muscle cells of the iris (Muskulus dilatator pupillae) is responsible for this pupil constriction. The paralysis of the upper eyelid muscle (musculus tarsalis) leads to the drooping of the upper eyelid (=ptosis). Enophthalmus of the eyes means that the eyes sink back into the orbit, while the disturbed sweat secretion is caused by damaged nerve fibers that control the sweat release in the body area.
The uneven sweat secretion is clearly visible on the skin. Cocaine eye drops on the pupil and the lack of pupil dilation are evidence of the borderline strand lesion of the sympathetic eye nerves. The subsequent administration of amphetamine eye drops can further narrow down the location of the damage.
The ophthalmologist will then make the diagnosis by consulting the clinical signs. Then, the location of the damage and the cause of the damage are examined. If Horner’s syndrome is accompanied by other signs of brainstem dysfunction, such as: the location of the damage must be clearly determined.
A circulatory disorder can be assumed if the symptoms developed very rapidly. A magnetic resonance imaging of the head is recommended to exclude a tumor disease or a circulatory disorder. Ultrasound examinations of the heart and the cervical vessels and a long-term ECG can detect cardiac arrhythmia.
If Horner’s syndrome is accompanied by signs of syringomyelia (a disease of the spinal cord) and there is therefore pain or paralysis in the arms and a reduced sensation of pain, it can be assumed that the nerve fibers are also affected there. Syringomyelia would become apparent in an MRI of the cervical spine. If Horner’s syndrome occurs after an accident and there is paralysis and/or loss of sensation in one arm, damage to the arm nerve plexus is to be assumed.
Due to these possible concomitant symptoms, the doctor makes the decision for further examinations
- A hemiplegia,
- Double images,
- Swallowing or speech disorders,
There is no treatment for the symptom Horner syndrome. However, by treating the causes, the signs of Horner’s triad can decrease. However, if there is a complete severance of the nerve tract, a complete recovery of the symptoms cannot be achieved.
The nerve fibers that control the dilation of the pupil as well as the eyelid gap width of the eye and the sweat production of the upper half of the body belong to the so-called sympathetic nervous system, which is part of the autonomous nervous system. A blockage of the Stellate ganglion also leads to Horner’s syndrome. The fibers emerge again from the spinal cord through the eighth cervical nerve root and form the first thoracic nerve root on one side of the body.Through a nerve plexus called the cervical cord, the nerve fibers continue to the internal carotid artery (Arteria carotis interna) and follow this vein in its forks through the middle cranial fossa to the eye.
It follows from this intricate and long course of the nerves that Horner’s syndrome can theoretically develop by a pathological process all the way from the brain stem to the eye. The nerve tract in the brain stem can be damaged by a circulatory disorder, usually in the context of Wallenberg syndrome associated with sensitivity disorders and cranial nerve deficits, or rarely by a tumor. A pathological cavity formation (syringomyelia) in the cervical marrow can damage the nerve fibers there.
A cancer of the upper tip of the lung (pancoast tumor) often damages the border strand itself. However, a so-called plexus lesion, i.e. an injury to the arm nerve plexus (e.g. in a motorcycle accident) in the area of the cervical spine, can also lead to the development of Horner’s syndrome.
In addition, inflammatory changes or tumors in the middle cranial fossa can damage the nerve fibers. The fibers emerge again from the spinal cord through the eighth cervical nerve root and form the first breast nerve root on one side of the body. Through a nerve plexus called the cervical border strand, the nerve fibers continue to move to the inner carotid artery (Arteria carotis interna) and follow this vein in its forks through the middle cranial fossa to the eye.
It follows from this intricate and long course of the nerves that Horner’s syndrome can theoretically develop by a pathological process all the way from the brain stem to the eye. The nerve tract in the brain stem can be damaged by a circulatory disorder, usually in the context of Wallenberg syndrome associated with sensitivity disorders and cranial nerve deficits, or rarely by a tumor. A pathological cavity formation (syringomyelia) in the cervical marrow can damage the nerve fibers there.
A cancer of the upper tip of the lung (pancoast tumor) often damages the border strand itself. However, a so-called plexus lesion, i.e. an injury to the arm nerve plexus (e.g. in a motorcycle accident) in the area of the cervical spine, can also lead to the development of Horner’s syndrome.
In addition, inflammatory changes or tumors in the middle cranial fossa can damage the nerve fibers. Mainly the eye symptoms are impairing for the affected person. It is precisely the disturbance of the pupillary reflex that significantly restricts the eye’s ability to perceive.
The drooping of the eyelid also narrows the field of vision (visible area of the eye) and impairs three-dimensional vision. It is also important to note that Horner’s syndrome is also very stressful for patients psychologically, because their facial expressions and facial expressions change.
