Neuro-Ophthalmological Manifestations of Horner's Syndrome: Current Perspectives

Abstract

Horner's syndrome (HS) is caused by a damage to the oculosympathetic pathway. HS may be congenital, but it is usually acquired and may reveal a life-threatening condition. According to the anatomic location of the underlying pathologic process, HS is classified as central, pre- or postganglionic, when the lesion affects the first, second or third-order neuron, respectively. Pharmacological testing, if available, can be used to differentiate HS from « pseudo-HS » in patients with mild symptoms. Given the financial burden that imaging of the entire oculosympathetic pathway represents, a targeted imaging approach is advised. Although in the majority of cases, clinical examination may predict etiology, in other cases pharmacological testing can help in the localization process. We searched PubMed data base for papers published before December 2022 that concerned Horner's syndrome, its neuro-ophthalmological manifestations and diagnosis. In this article, we describe the main neuro-ophthalmological manifestations of the three types of HS, the most common etiologies, and a targeted diagnostic strategy in each type.

Keywords: Horner’s syndrome; neuro-ophthalmology; pharmacological testing.

Figure 1

External photograph demonstrating left Horner’s syndrome secondary to a left neck tumor in a 62-year-old woman. Note left ptosis in daylight (figure at the top) and left miosis in the left eye on the right more pronounced in dim light (figure at bottom). An informed written consent was obtained from the patient.

Figure 2

Right congenital Horner’s syndrome in a 10-year-old girl. Right ptosis, iris hypochromia and anisocoria in dim light can be seen (right eye on the left). An informed written consent was obtained from the patient.

Figure 3

A 42-year-old woman presented with a 6-month history of persistent headache associated with a posterior neck pain that recently worsened. Right Horner’s syndrome was found on examination with right ptosis, anisocoria and conjunctival hyperemia (right eye on the left). CT-scan revealed the presence of bilateral Eagle’s syndrome, which was more severe on the right side. CBH occurrence is explained by a compression along the oculosympathetic pathway by the abnormal elongation of the styloid process. An informed written consent was obtained from the patient. Reprinted from Maamouri R, Ouederni M, Oueslati Y, Mbarek C, Chammakhi C and Cheour M. Acute Painful Horner’s Syndrome Revealing Eagle’s Syndrome: A Report of Two Cases. Neuro-Ophthalmology. 2022;46(4), 244–247.