Question

A 75 year old man was brought into the clinic by his daughter after she noticed that his right eyelid was drooping. She wasn’t sure how long his symptoms had been going on for. During the physical examination, you notice that although his right eyelid was drooping, eye movements were normal. His right pupil appeared to be smaller than the right.

1. What is your differential diagnosis?

2. What part of the nervous system appears to be malfunctioning?

Answer 1

Horners Syndrome-

In Horners Syndrome-Sympathetic Pathway of Nervous System is Affected.

Sympathetic Pathway-

1st Order Neurons-Hypothalamus synapse withIntermedio Lateral Horn of Spinal Cord(C8-T1)

2nd order Neuron-Exit at T1 Level synapse at Superior Cervical Ganglion.

3rd Order Neuron-From Superior Cervical Ganglion to Plexus around Internal Carotid Artery,Enters the Orbit as Long Ciliary Nerve.

Long Ciliary Nerve Supplies-

1.Dialator Pupillae-That cause pupillary Dialation

2.Smooth muscles of Eyelid

3.Sweat glands of Forehead and face.

so Any leasion in this Pathway Causes Horners Syndrome-

Features of Horners Syndrome-

1.Miosis-(Pupillary constriction) due to paralysis of sphincter pupilla

2.Partial Ptosis-Due to paralysis of smooth muscles of Lid

3.Anhidrosis-Damage to Sweatglands

To differentiate cause of Ptosis(Drooping of upper Eyelid) from Horners Syndrome and 3rd nerve Palsy(Occulomotor Nerve Palsy)

Horners Syndrome	3rd nerve Palsy
Usually Partial Ptosis	Complete ptosis
Pupillary constriction	Pupillary dialation
Eye movements are not affected	eye movements are Affected