Horner’s Syndrome

Horner’s syndrome is a condition caused by damage to the nerve pathway that leads from the brain to the eye and face on the affected side of the body. It’s considered a rare condition, affecting only 1.42 out every 100,000 people under the age of 19. Around 1 in every 6,250 cases of Horner’s Syndrome happen at birth, and 65% of the cases are from birth injuries or trauma.

Horner’s Syndrome Symptoms

Horner’s syndrome symptoms are typically limited to the side of the affected face. Some infants may experience every symptoms while others may have only one or two. The most common symptoms include:

  • Miosis in the affected eye
  • Different pupil sizes
  • A delayed time in dilation when the affected pupil is under a dimmed light
  • Ptosis: dropping of the affected upper eyelid
  • The affected eye may appear sunken
  • Little to no sweating on the affected side of the face
  • Patch of skin isolated on the affected side of the face
  • The affected eye may appear bloodshot
  • Lack or redness or a “flushed face” appearance after extreme heat or physical activity
  • The iris in each eye may be a different color

Horner’s Syndrome Causes

There are a variety of causes to Horner’s syndrome, but infants typically develop the disorder either congenitally or via an injury during childbirth.

Congenital disorders that lead to Horner’s syndrome include:

  • Artery problems
  • Carotid artery ischemia
  • Agenisis

Causes of Horner’s syndrome due to birth trauma include:

  • Improper use of forceps during delivery
  • Pulling too hard on the infant, causing tears to the sympathetic nerves
  • Shoulder dystocia
  • Failure to respond to fetal distress in time
  • Failure to schedule and perform a cesarean section (C-section) surgery in time
  • Failure to properly detect an infant in breech position and deliver in time

Horner’s Syndrome Treatment

When an infant shows symptoms of Horner’s syndrome, a pupil dilation test  is usually administered to see how the pupil responds to stimulation. A physical exam may follow, accompanied by an MRI to determine any birth injuries that may have led to the disorder.

There is no specific treatment for Horner’s syndrome, but physicians typically identify and treat the underlying reason that the disorder developed.  For instance, if it was caused by a brachial plexus injury, the nerves in the brachial plexus must heal in order to treat Horner’s syndrome. In some instances, the nerve injuries will clear up naturally, but in other cases medication and/or surgery may be required.

Horner’s Syndrome Prognosis

While Horner’s syndrome may clear on its own or heal with medication and surgery in some infants, others may experience lifelong problems with the affected side of the face. The prognosis will greatly depend upon the severity of the disorder as well as how quickly it’s detected and treated. For example, if an infant suffers from oxygen loss after a difficult birth, Horner’s syndrome may clear eventually, but the baby may develop cerebral palsy or other serious disorders as a result of oxygen loss. Furthermore, if the treatment for the underlying problem is not successful, an infant may live with long-term injuries to the affected side of the face.