Horner’s syndrome, also known as Horner-Bernard syndrome or oculosympathetic palsy, is a rare combination of symptoms, usually caused by another medical issue such as a tumor, stroke, or spinal cord injury. This condition sometimes results from the disruption of a nerve pathway in the sympathetic nervous system, between the face and eye on one side of the body, and the brain.
The Sympathetic Nervous System
The sympathetic nervous system regulates perspiration, heart rate, blood pressure, pupil size, and other functions that help the body respond rapidly to changes in the surrounding environment.
The nerve pathway that may be disrupted — sometimes leading to Horner’s syndrome — is comprised of three different types of nerve cells, or neurons: first, second, and third-order neurons.
- First-order neurons lead from the hypothalamus (located at the base of the brain), through the brainstem, and into the upper part of the spinal cord. A disruption in the nerve function of this region, such as a tumor, stroke, neck trauma, cyst in the spinal column, or diseases that compromise the protective sheath over neurons (called myelin) may lead to Horner syndrome.
- Second-order neurons extend out from the spinal column and across the upper chest, into the side of the neck. Nerve damage in this area may be caused by lung cancer, traumatic injury, chest surgery, tumors in the myelin sheath, or damage to the main blood vessel from the heart.
- Third-order neurons are in a path that extend from the sides of the neck, leading to the skin and muscles of the face, eyelids and iris. When nerve damage occurs in this area, it is often associated with migraine or cluster headaches, migraines, carotid artery or jugular damage, or infection or tumors near the base of the skull.
While there is no treatment specifically for Horner’s syndrome, treating the underlying cause may help to reestablish nerve function. In some cases, however, the underlying cause cannot be determined. When this applies, it’s known as idiopathic Horner’s syndrome.
Symptoms of Horner’s Syndrome
Most often, Horner’s Syndrome affects just one side of the face. Many of its common symptoms can be subtle or difficult to identify, but include:
- Drooping (ptosis) of the upper eyelid
- Slightly elevated lower eyelid (“upside-down” ptosis)
- Sunken eye appearance
- Little to no sweating on the affected side of the face (the entire side or an isolated area)
- Delayed or reduced opening (dilation) of the affected pupil under dim lighting
- A noticeable asymmetry in pupil size from one eye to the other (anisocoria)
- A consistently small pupil size (miosis)
In children, Horner’s syndrome may have additional symptoms, including:
- Lighter iris color in the eye on the affected size (in infants)
- Lack of typical flushing or redness in the face on the affected side, which would normally occur with physical activity, emotional reactions, or heat
If symptoms of Horner’s syndrome come on suddenly or after a traumatic injury, or come with other conditions such as dizziness, vision problems, lack of muscle control or muscle weakness, or severe and sudden neck pain or headache, emergency care should be sought.
As stated above, Horner’s syndrome may result in uneven pupil size between the eyes, drooping upper eyelid, and headaches. These and other symptoms apply to 10-year-old Cassie. Cassie’s Horner syndrome was the result of having a golf-ball sized, non-cancerous mass removed from her chest. Her mother writes:
“When our daughter, Cassie, was 5 years old an unknown mass was discovered in her chest. After many tests and MRIs, the mass was said to be benign. Thankfully, we were able to leave it alone for several years until it began to rapidly grow. After a lengthy 11 hour surgery, the mass was gone, but Cassie was expected to experience some complications. She was not supposed to be able to move her left arm and her voice was supposed to sound like someone who had smoked for several years. Her perseverance and will power has amazed my husband and me! Cassie played basketball for a local recreational league last year and is in the school chorus this year!”
We have truly been blessed by her good health and ability to take on more and more. After her surgery, I noticed that her face would flush on one side, and her pupil would dilate on the same side. Through research, we have found that Cassie has a rare form of nerve damage called Horner’s Syndrome. Because of all the pulling and moving of her nerves in the chest cavity during surgery, it has created several issues that we continue to learn about. Cassie only sweats on one side of her body, her eyelid droops a little, and her pupil is always dilated. These are issues that we are learning to live with daily, and most of them are an easy fix. We take extra water to the playground, we use cool rags and rest more often than most children, and we wear sunglasses outside to ward off the bright rays of the sun.”
Cassie began having headaches when she returned to school after her surgery, and we could not come up with a solution. I knew that the fluorescent lighting inside the school was the culprit, but the hats and visors we were sending to school were not helping. I had heard about Axon Optics and the light filtering glasses, so we wanted to give them a try. This was the best decision for Cassie! Her headaches stopped, and she began to act like herself again. These special glasses have been a blessing to my daughter and to my family. She is 10 years old and keeps up with her glasses like they are a treasure. Thank you, Axon for making a product that gave us our sweet, giggly girl back!”
-Tiffany and Jason
Thank you, Tiffany and Jason, for sharing your daughter’s story with us. Cassie sounds like a real go-getter, and we are so glad that Axon Optics lenses have helped her! We had never even heard about Horner’s syndrome until Cassie’s family wrote us, and we love learning of all the unexpected ways our glasses are able to help our customers.
If you have a story to share about how Axon Optics lenses have helped you, we’d love to hear it! Please send it to us at [email protected]