About oculosympathetic palsy
What is oculosympathetic palsy?
Horner syndrome is a relatively rare disorder characterized by a constricted pupil (miosis), drooping of the upper eyelid (ptosis), absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity that protects the eye (enophthalmos). These are the four classic signs of the disorder.
The congenital, and more rare, form of Horner syndrome is present at birth but the cause is not known. Most often, Horner syndrome is acquired as a result of some kind of interference with the sympathetic nerves serving the eyes. The underlying causes can vary enormously, from a snake or insect bite to a neck trauma made by a blunt instrument.
What are the symptoms for oculosympathetic palsy?
Signs and symptoms, particularly ptosis and anhidrosis, may be subtle and difficult to detect.
Additional signs and symptoms in children with Horner syndrome may include:
- Lighter iris color in the affected eye of a child under the age of 1
- Change in color on the affected side of the face that would typically appear from heat, physical exertion or emotional reactions
What are the causes for oculosympathetic palsy?
Horner syndrome is caused by damage to a certain pathway in the sympathetic nervous system. The sympathetic nervous system regulates heart rate, pupil size, perspiration, blood pressure and other functions that enable you to respond quickly to changes in your environment.
The nerve pathway affected by Horner syndrome is divided into three groups of nerve cells (neurons).
This neuron pathway leads from the hypothalamus at the base of the brain, passes through the brainstem and extends into the upper portion of the spinal cord. Problems in this region that can disrupt nerve function related to Horner syndrome include:
- Diseases that cause the loss of the protective sheath on neurons (myelin)
- Neck trauma
- Cyst in the spinal column (syringomyelia)
This neuron path extends from the spinal column, across the upper part of the chest and into the side of the neck. Causes related to nerve damage in this region may include:
- Lung cancer
- Tumor of the myelin sheath (schwannoma)
- Damage to the main blood vessel leading from the heart (aorta)
- Surgery in the chest cavity
- Traumatic injury
This neuron path extends along the side of the neck and leads to facial skin and muscles of the iris and eyelids. Nerve damage in this region may be associated with the following:
- Damage to the carotid artery along the side of the neck
- Damage to the jugular vein along the side of the neck
- Tumor or infection near the base of the skull
- Cluster headaches, a disorder that results in cyclical patterns of severe headaches
The most common causes of Horner syndrome in children include:
- Injury to the neck or shoulders during delivery
- Defect of the aorta present at birth
- Tumor of the hormonal and nervous systems (neuroblastoma)
In some cases, the cause of Horner syndrome cannot be identified. This is known as idiopathic Horner syndrome.
What are the treatments for oculosympathetic palsy?
There's no specific treatment for Horner syndrome. Often, Horner syndrome disappears when an underlying medical condition is effectively treated.
What are the risk factors for oculosympathetic palsy?
Oculosympathetic palsy, also known as horner syndrome, is a rare condition that presents with partial ptosis, miosis, and loss of sweating due to disruption in sympathetic nerve supply. Insults at any point along the sympathetic chain that finally innervates the ciliary muscles of the eye and sweat glands of the face lead to the syndrome. Commonly, it is acquired from injuries. However, rare cases of genetic origin have been reported.
A stroke in the brain may have an impact on the blood supply to the pathway in love in the disease and may pose risks of nerve damage.
1. Traumatic brain injury: The sympathetic nerve starts from hypothalamic structures, and any traumatic insults that can disrupt the region may prompt the loss of function of the underlying nerve.
2. Neck injury: The sympathetic nerves that innervate the face and eye run down the spinal cord through the neck. Injuries or acute compressions may sever the first-order neurons in the neuronal pathway.
3. Lung cancer and surgery in the chest cavity: Passing through the neck down the spinal cord, the second-order neurons enter the thoracic level before exiting the spinal cord. Damages are likely to occur during the surgeries and invasion of lung cancer metastasis. These may lead to nerve damage.
Tumor or infections near the base of the skull is another risk factor, as metastasis can be unpredictable and spatial involvement of tumors has significant effects.
Decreased pupil size,A drooping eyelid and decreased sweating on the affected side of the face
A condition that affects the face and eye on one side of the body
Over-the-counter pain relievers,Medications to reduce nerve spasms, such as gabapentin (Neurontin), carbamazepine (Tegretol), or phenytoin (Dilantin),Corticosteroids to reduce inflammation,A splint to support the hand and reduce painful symptoms,Physical therapy to increase muscle strength and function,Occupational therapy to minimize further injury
Is there a cure/medications for oculosympathetic palsy?
If you are experiencing any of the symptoms of Horner’s syndrome, it’s important that you make an appointment with a medical professional. Getting a proper diagnosis and finding the cause is important. Even if your symptoms are mild, the underlying cause may be something that needs to be treated.