Horner ‘s syndrome is a specific nerve damage that affects various eye muscles. The disease consists of a three-part symptom complex (a so-called symptom triad): This symptom triad includes a drooping upper eyelid, a clear constriction of the pupil and a sunken eyeball in the orbit.
What is Horner Syndrome?
According to abbreviationfinder, the tripartition of constricted pupils, drooping eyelid and sunken eye described above is characteristic of Horner’s syndrome.
In addition to these directly visible symptoms, disturbed sweat production can occur in the various regions of the upper half of the body. Horner’s syndrome is not considered a disease in its own right, but rather a partial symptom of many other diseases.
Nevertheless, some findings indicate that various nerve injuries are responsible for the occurrence of the symptom. The damaged nerves can be located anywhere in the body and can be triggered by various diseases. Familial and genetic causes are also no longer excluded.
Causes
The hypothalamus (an important area in the human brain) is responsible for controlling the muscles that can lead to the symptoms typical of Horner’s syndrome. In order to get from the hypothalamus to the eye and vice versa, the nerve tracts have to complete a complicated circuit via the spinal cord.
Cranial nerves can be damaged at any time along this path. There is often damage to the nerve tracts due to circulatory disorders (this is usually localized in the brainstem) or a brain tumor that affects the nerves in question and can damage them. Cancerous growths at the top of the lungs and pathological cavities in the cervical cord can also lead to nerve damage and thus trigger Horner’s syndrome.
In addition, inflammation localized in the middle cranial fossa can also lead to the symptom triad of Horner’s syndrome.
Symptoms, Ailments & Signs
In most cases, Horner’s syndrome presents with symptoms in the eye area on one side of the body, but not on both sides. The disease manifests itself in the area of the pupil, the eye socket and the eyelid.
The function of the pupil is disturbed in Horner’s syndrome. Regardless of the brightness, the pupil is always narrowed. As a result, patients complain that their vision is limited in the dark because the ambient light does not reach the retina sufficiently.
Due to the failure of the orbitalis muscle, the eyeball has sunk slightly into the skull. In healthy people, the muscle causes the eye to protrude slightly. Depending on the severity of the disease, this retraction of the eyeball may be more or less visible.
Many patients suffering from Horner’s syndrome complain of a drooping eyelid. This symptom is due to a dysfunction of the Müllerian muscle. In addition to these three classic symptoms, there are other manifestations.
They also only appear on one side of the face. Different colors of the iris, pigment disorders or dilated vessels are indications of Horner’s syndrome. In some cases, patients no longer sweat properly on one side of their face. One speaks then of a disturbance of the sweat secretion.
Diagnosis & History
The three-part symptom complex is easy to recognize. In patients with Horner’s syndrome, the damaged pupil is relatively smaller than the intact pupil, the eyelid droops, and can only be raised minimally, even with effort.
In Horner syndrome, the pupil dilates slowly and incompletely in response to light. The other symptoms are also clearly recognizable, because e.g. For example, increased sweat secretion can be clearly observed on the skin in some body regions, while some regions show no sweat production at all.
By administering cocaine and amphetamine eye drops, the damage can be localized and its extent identified. The physical impairment affects only the eye and the eye muscles. For example, the perception behavior of the eye can change in a negative sense due to the narrowing of the pupils, the field of vision is reduced due to the drooping eyelid and three-dimensional vision can be significantly impaired.
In most cases, patients with Horner syndrome suffer particularly from psychological stress, since the facial expressions and facial expressions can change significantly as a result of the symptoms.
In the further course, it must be concluded for what reason the symptoms of Horner’s syndrome occur and which other disease is responsible for it. This is the only way to effectively treat the symptoms.
Complications
Horner’s syndrome causes significant eye problems that can have an extreme impact on the life of the person affected. In most cases, the pupils are greatly enlarged and the eyeball is retracted. Furthermore, the upper eyelids can also droop and thus have a negative impact on the patient’s aesthetics. The cosmetic complaints often lead to inferiority complexes or reduced self-esteem.
Patients are often ashamed of the symptoms. In severe cases, it can also cause visual disturbances or other visual impairments. These usually have a negative effect on the everyday life of those affected and also reduce the quality of life. In most cases, Horner’s syndrome and its symptoms are not treated directly.
Instead, the underlying disease is always examined and treated, with no particular complications occurring. The symptoms usually disappear when the underlying disease has also been defeated. Life expectancy is not altered or reduced by Horner syndrome. The disease in most cases does not go away on its own, so without treatment, the discomfort increases.
When should you go to the doctor?
If Horner’s syndrome is suspected, a doctor must be consulted promptly. Typical warning signs that need to be clarified are constricted pupils and a sunken eyeball, often associated with blurred vision, pain in the eye area and excessive sweating. When these symptoms appear, there is most likely a serious medical condition that needs to be investigated and treated if necessary. It is not always Horner’s syndrome, but medical education is necessary in any case.
This is especially true if the symptoms appear without a reason and persist for a longer period of time. Individuals who have had a brain tumor in the past are particularly prone to developing Horner’s syndrome. Nerve disorders and syringomyelia are also possible causes of the syndrome. If you are one of these risk groups, it is best to speak to the responsible doctor. In addition to the family doctor, an ophthalmologist or a neurologist can also be involved. In the event of a medical emergency, emergency medical treatment is required.
Treatment & Therapy
No specific therapy has been developed to treat Horner’s syndrome. This is mainly because many different causes can produce the suffering of Horner’s Syndrome.
By treating the actual disease – which is the cause of Horner’s syndrome – the tripartite symptoms are also alleviated.
The treatment is therefore always individually tailored to the actual suffering of the patient and goes hand in hand with the treatment of the causative disease. If the treatment improves the state of health, in most cases there is also an improvement in Horner’s syndrome.
If the symptoms of Horner’s syndrome are not relieved, other causes for these symptoms can be identified.
Outlook & Forecast
So far, there is no treatment method that can specifically and completely cure Horner’s syndrome. Patients and doctors must therefore broaden their perspective and search for the cause. The reasons for Horner’s syndrome can often be eliminated. If this is successful, the three typical symptoms of miosis, ptosis and enophthalmos usually subside. In principle, the probability of a positive outcome increases if a disease is treated at an early stage. If there is no therapy, the symptoms increase. Horner syndrome itself does not affect life expectancy.
Sometimes the nerve is severed by the underlying disease. Those affected then have to deal with Horner’s syndrome for the rest of their lives. A cure is impossible. This prospect throws many patients into a deep inner conflict. As facial expressions change, they often suffer from reduced self-confidence. The aesthetic effects that cause the drooping eyelid, among other things, can hardly be hidden. In this situation there is a risk that a long psychosis will develop. The quality of life suffers. Getting back into everyday life from this situation is impossible for many without outside help.
Prevention
The patient can hardly contribute to the prophylaxis of Horner’s syndrome. Horner’s syndrome develops due to another disease, the development of which most often patients have no control over. After all, a tumor cannot be predicted and ultimately avoided, just as little as a circulatory disorder or a motorcycle accident with damage to the arm nerve plexus, which can also lead to the symptoms of Horner’s syndrome.
Aftercare
In Horner’s syndrome, the options and measures for aftercare are very limited in most cases. Since this is also a congenital disease, this disease cannot be treated causally, but only purely symptomatically. If you wish to have children, genetic counseling can also be carried out to prevent the disease from being passed on.
In the case of Horner’s syndrome, the focus is therefore primarily on early detection of the disease so that the symptoms do not worsen further. The treatment of Horner’s syndrome depends primarily on the exact underlying disease. An improvement cannot always be achieved.
If the illness leads to mental upsets or depression, loving care for one’s own family and friends has a very positive effect on these symptoms. Regular check-ups by a doctor are also very important. If the syndrome is treated by taking medication, it is important to ensure that it is taken correctly and regularly. Possible interactions with other medications must also be taken into account. In the case of children, parents should pay particular attention to correct intake.
You can do that yourself
The patient cannot contribute to the treatment of Horner’s syndrome himself. In any case, the affected person is dependent on medical treatment in order to limit the symptoms of the syndrome. It is also usually not possible to prevent the syndrome.
In many cases, patients need support and psychological treatment. This can come from your own friends and family, but should also be accompanied by visits to a psychologist. Children must be informed about the disease and its possible consequences in order to ensure the child’s psychological stability. Talking to other sufferers can also help. Due to the visual problems, the patients are dependent on the help of other people in their everyday life. Warm and warm care has a very positive effect on the course of Horner’s syndrome.
Due to the disturbed production of sweat, patients should wear airy and light clothing, especially in summer, in order to avoid sweating and thus unpleasant situations. In some cases, the circulatory disorders can be reduced by massage or heat applications. However, a complete cure of Horner’s syndrome is not possible.
