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Case Reports
. 2016 Oct-Dec;11(4):442-444.
doi: 10.4103/2008-322X.194146.

Horner Syndrome Following Thyroid Surgery: The Clinical and Pharmacological Presentations

Giuseppe Giannaccare  1 , Corrado Gizzi  1 , Michela Fresina  1
Affiliations
Case Reports

Horner Syndrome Following Thyroid Surgery: The Clinical and Pharmacological Presentations

Giuseppe Giannaccare et al. J Ophthalmic Vis Res. 2016 Oct-Dec.

Abstract

Purpose: To report the clinical and pharmacological findings of a patient with iatrogenic Horner syndrome (HS) which occurred after thyroid surgery.

Case report: A 29-year-old man was referred to our emergency ward due to anisocoria and unilateral eyelid ptosis reported by the patient immediately after a recent thyroidectomy for a papillary carcinoma. Ophthalmologic examination revealed 3 mm ptosis of the right eyelid. In dim illumination, the right and left pupil size was measured 3 and 6 mm, respectively. In bright illumination, the amount of anisocoria decreased; the near pupillary reaction was intact. Brain and neck magnetic resonance imaging and chest radiography were normal. Pharmacological tests with 10% cocaine, 1% hydroxyamphetamine and 1% phenylephrine localized the interruption of the oculosympathetic pathway with postganglionic third-order neuron involvement. After 6 months of follow-up, no sign of recovery was recorded.

Conclusion: Despite HS could appear to be a rare complication of thyroid surgery, it is of importance for the neck surgeons to be aware that oculosympathetic pathway (OSP) is a potentially vulnerable structure with close anatomical relationship with the thyroid gland, and for the ophthalmologists that HS may occur secondary to neck surgery and taking an accurate history is mandatory.

Keywords: Horner syndrome; Miosis; Ptosis; Thyroid Surgery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Right eye miosis, blepharoptosis and lower eyelid margin “inverse ptosis”.
Figure 2
Figure 2
Decreased anisocoria in bright illumination.
Figure 3
Figure 3
Pupil dilatation and temporary regression of the ptosis following instillation of 1% phenylephrine eye drop.
See this image and copyright information in PMC

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