Ptosis with Acquired Horners

Horner's syndrome or Horner syndrome is a clinical syndrome caused by damage to {the} sympathetic nervous system. It is also known by {the} names Bernard-Horner syndrome or Claude Bernard-Horner syndrome or as oculosympathetic palsy.

• Signs found in all patients on affected side of face include ptosis (drooping upper eyelid from loss of sympathetic innervation to {the} Müller or superior tarsal muscle, upside-down ptosis (slight elevation of {the} lower lid), and miosis (constricted pupil) and dilation lag.
• Enophthalmos ({the} impression that {the} eye is sunk in) and anhydrosis (decreased sweating) on {the} affected side of {the} face, loss of ciliospinal reflex and blood shot conjunctiva could occur depending on {the} site of lesion.
• Also flushing of {the} face is common on {the} affected side of {the} face due to dilation of blood vessels under {the} skin.

In children Horner syndrome often leads to a difference in eye color between {the} two eyes (heterochromia). This happens because a lack of sympathetic stimulation in childhood interferes with melanin pigmentation of {the} melanocytes in {the} superficial stroma of {the} iris.

Pathophysiology

Horner syndrome is due to a deficiency of sympathetic activity. The site of lesion to {the} sympathetic outflow is on {the} ipsilateral side of {the} symptoms. The following are examples of conditions that cause {the} clinical appearance of Horner's syndrome:

• First-order neuron disorder: Central lesions that involve {the} hypothalamospinal pathway (e.g. transection of {the} cervical spinal cord).
• Second-order neuron disorder: Preganglionic lesions (e.g. compression of {the} sympathetic chain by a lung tumor).
• Third-order neuron disorder: Postganglionic lesions at {the} level of {the} internal carotid artery (e.g. a tumor in {the} cavernous sinus).

If someone has impaired sweating above {the} waist affecting only one side of {the} body, yet they do not have a clinically apparent Horner's syndrome, then {the} lesion is just below {the} stellate ganglion in {the} sympathetic chain.

Neurologic conditions associated with Ptosis

• Horner's syndrome
  • Heterchromia (iris)