Pathology: Miosis,ptosis and anhydrosis caused by lesions in the oculosympathetic pathway
Aetiology: Central: Lesions involvinghypothalamus, brain stem and cervical cord such as
infarct, bleed and demyelination
Preganglionic: Cervicothoracic cordtrauma, tumors or syrinx, lower brachial
plexus injuries, apical lung tumors, cervicalrib
Postganglionic: Migraine, clusterheadache, internal carotid artery dissection,
cavernous sinus pathologies
Symptoms: Usually mild and can go unnoticed by patient
Signs: Miosis, ptosis andanhydrosis on one side of the face
Investigations: Special tests: Apraclonidine test (topicalalpha agonist which constricts normal eye
and reverses Horner’s eye) help confirm the diagnosis
Imaging: Chest X-ray: to identify apical tumour
MRI/CT: to assess tounderlying pathology
Treatment: Conservative: Symptoms of Horner’ssyndrome are usually mild and do not require
any intervention.
Surgical: Correction of ptosis couldbe considered in some cases.
Complications: Dependent on underlying cause
Prognosis: Dependent on underlyingcause
