Horner’s Syndrome Definition, Reason, Symptoms, Treatment & Prevention
Definition
Horner’s syndrome is a collection of symptoms caused by nerve damage to the nerve pathways from the brain to the face and eyes. Characteristics of this syndrome are eyeball drooping, ptosis of the upper eyelid, slightly raised upper eyelid, constriction of the pupil, anhidrosis (decreased sweating), and redness of the affected side of the face.
The name of this syndrome was determined by a Swiss ophthalmologist, named Johann Friedrich Horner. Friedrich was the first to describe this phenomenon in 1869.
Horner’s Syndrome Symptoms
There are several symptoms of patients with Horner’s syndrome, namely:
- Enophthalmos. Disturbance in which the eyeball is located deeper than it should be, in the orbital space
- Anhidrosis, a skin condition in which the skin becomes dry and does not sweat
- Miosis (shrinkage of the pupil of the eye)
- The difference in the size of the pupils of the two eyes
- Redness of the skin around the eyes due to dilation of blood vessels
- The eyelids are raised.
Horner’s Syndrome Reason
Horner’s syndrome is primarily caused by damage or interference with the sympathetic nerve pathways. Symptoms of Horner’s syndrome occur due to a process in the spine at cervical VIII to thoracic I. In this area, there are sympathetic nerves that affect ptosis.
The causes of Horner’s syndrome are divided into three, namely:
- First-order neurons, which are found in the hypothalamus, brainstem, and spinal cord. Conditions that cause disruption of the first-degree neurons are stroke, tumors, and neck injuries.
- Second-level neurons. It is found on the spine and neck on the side of the neck. Conditions that can cause disturbances in the second-level neurons are neck and lung malignancies, myelin tumors, and injuries.
- Third-level neurons. Postganglionic lesion at the level of the internal carotid artery releasing norepinephrine.
Horner’s Syndrome Diagnosis
Determination of the diagnosis of Horner’s syndrome is based on medical interviews and physical examination. Sufferers will complain of symptoms in the form of disturbances in the eyelids, and lack of sweating on the affected side.
On physical examination, the eyelids are unbalanced and the pupils look miotic. There are three types of examinations that can be used to determine the diagnosis of Horner’s syndrome, namely:
- Cocaine drop test. The mechanism of action of cocaine is to block the reuptake of norepinephrine that is normally released from nerve endings. If there is interference with the sympathetic pathway, norepinephrine is not released. So that the administration of cocaine has no effect in causing mydriasis (dilatation).
- Paredrine test. This examination helps localize the cause of miosis. This test can determine the cause of miosis especially if the cause of miosis is in the pathway of third neurons (neurons that release norepinephrine into the synaptic cleft).
Horner’s Syndrome Treatment
Treatment for Horner’s syndrome depends on the underlying cause. The goal of treatment is to eradicate the underlying disease process.
Prevention
There is no specific prevention for Horner’s syndrome, but the symptoms can be managed with medical therapy and drugs.