Thursday, February 5, 2009

What the heck is Horner's Syndrome?

Horner's syndrome is characterized by an interruption of the oculosympathetic nerve pathway somewhere between its origin in the hypothalamus and the eye. The classic clinical findings associated with Horner's syndrome are ptosis, pupillary miosis and facial anhidrosis. Other findings may include apparent enophthalmos, increased amplitude of accommodation, heterochromia of the irides (if it occurs before age two), paradoxical contralateral eyelid retraction, transient decrease in intraocular pressure and changes in tear viscosity.

And, apparently, Sophia has it. It's not as bad as it sounds. Basically, for Sophia, it's just a difference in pupil size and speed of dilation of the eyes. If you look carefully at the photo below, you can see that her left pupil is larger than the right.

The right pupil is experiencing pupillary miosis (see paragraph above). According to her eye doctor, she has Third Order or Third Neuron Horner's Syndrome, which is the mildest version. He feels that it is probably the result of some trauma from her early delivery and being in the hospital so long. He said he thinks she has a postganglionic lesion. Again, sounds worse than it is. That's just some stretching of that particular nerve in her neck that has caused the right eye to dilate slower and not as much. Thus far, Sophia is not exhibiting ptosis (droopy eyelid) or facial anhidrosis (reduced sweating on that side of her face). It is likely, though that she will have heterochromia of the irides (her eyes will end up being two different colors). Again, Dr. Henry thinks this is 'normal' for Sophia, and is not overly concerned. She will be rechecked in six months to make sure there is no change in the condition, and that her eyes are growing at the same rate. If it causes her eyes to grow at different pace, she will get glasses. However, it seems likely that she will have glasses at some point, anyway, given my history and the fact that she's already significantly more near sighted (less farsighted) than most babies her age!

This is just one more thing that makes our sweet baby girl unique! I'm praying that it will stay this way and not have any adverse impact on her visual development. For right now, we can just wait to see if one of those pretty blue eyes turns green!


Jessica said...

She will be SO STINKIN' cute in glasses! : )

Anonymous said...

I found your blog after a google search for Horner's Syndrome Images. I'll spare you a super long story, but an Opthomologist has said that my 6mo old son does NOT have Horner's but the Neurologist says that he might.. sigh. The neurologist wants us to put our 6mo old under anestesia for a 3 hr MRI!! How was your daughter formally diagnosed with Horner's??? If you're comfortable sharing, my email is

Anonymous said...

Hi. My 9 month old was diagnosed with horners syndrome about 2 months ago. I came across your blog as i'm trying to research.
How is she doing? Has her eye color changed thus far?
Did you get an MRI to rule out tumors?

I hope you don't mind me asking. We are trying to decide if we should do the MRI.

Thank you for sharing-- it's made me feel better about my daughter.

Hope all is well. thanks again.
Kelly Dupree

Anonymous said...

by the way, sophia is absolutly beautiful.

Slinkard Family said...


Sophia is doing really well. No, we did not have an MRI to rule out tumors. We subsequently had an MRI that diagnosed her CP. The eye specialist felt that Sophia's Horner's Syndrome was the result of her premature birth, and thus some sort of one-time nerve trauma, as opposed to being caused by tumors. Her eyes are still both very blue, so no color changes yet. We get regular eye check-ups, and we see a neurologist every six months.

The MRI's for little ones are tough. However, I think it's harder on the parents than the little ones. They 'sleep' through the whole things. I'd say listen to your care provider, get a second opinion, and trust your mommy instincts. And, thanks for the compliment.

Anonymous said...

Dear Slinkard Family,
I can't tell you how much I appreciate your response. I'm so happy to hear Sophia is doing great. Are you seeing the neurologist specifically for Horners Syndrome every six months or for CP?

My daughter Ryan was born with torticollis- basically she was in womb with a kinked neck so her neck muscle on one side was shorter than the other side. Hence, we've been working with physical therapy to correct it. She is doing great and basically her neck tilt is gone.
I truly believe that the torticollis is the cause of horners, but there are no reported cases linking tort and horners. She is developing perfectly and actually her tosis in her eye gets better every day. when she is sleepy is when you can notice most.
The neuroligist wants us the get a mri to be safe, but as you said... it's much harder for the parents. the hard things is- there is not much information around horners and infants. when i start to get antsy about it, i start to google. UGH..

Anyway, thanks so much!

Good luck with little sophia! She is a doll.

Slinkard Family said...


We see the neurologist because of the CP, not because of the Horner's Syndrome. We see an eye specialist for that every six months just to ensure everything is still going okay.

I've heard of the condition your daughter was born with. Fortunately, it seems pretty treatable with therapy. Sophia doesn't have much ptosis, just a difference in pupil size.

Best of luck to you. Keep me posted, if you'd like. I'd love to hear more from you!

Abby said...

I am so glad I found your blog. I noticed my son had different sized pupils the day that we came home from the hospital. I finally convinced his doctor to refer us to an ophthalmologist at 6 months. He had a MRI of the face, neck and chest and nothing was found along the nerve as well (his Horner's syndrom is on the right side but unfortunately they found an aneurysm on the left carotid artery that has nothing to do with his right side Horner's Syndrome). We saw a Neuro Surgeon for the Horner's Syndrome and a Neuro Ophthalmologist. The Neuro Opthalmologist used cocaine drops in my son's eye to confirm that he does have Horner's Syndrome. His Horner's Syndrome will not affect him other than his eyesight as he is already nearsighted and he may end up with two different colored eyes. I was going crazy trying to find answers for so long. I couldn't find anything on the internet to help me get through my nerves while waiting for answers. I am so glad your posted this blog. Your Sophia is beautiful! Her eyes are exactly like my son's.

Devon said...

I'm so glad I'm not alone! When my son was about a month old, I noticed that his pupils were uneven. My family was telling me I was nuts and they could see no difference. But I persisted and we took him to an ophthalmologist and a neurologist and they both confirmed the he has Horner's. We didn't get an MRI but both doctors think that he will be just fine and that nothing bad is causing it. I still get nervous from time to time though. He doesn't seem to have any drooping and his eyes are both hazel, though they were blue until he was about 14 months old.

Just thought I'd share my experience, and thank you for sharing yours!

Anonymous said...

I think my daughter has horners but no drs will do anything to help me! :( does the small one ever fully dilate?

Anonymous said...

Hello im lookin for some answers...i was hoping you can help. I have a 2mnth old her right eye has a small pupil yoy can tell automatically. She also has a cataract in the same eye. Shes ashealthy as can be i have noticed her left eye is slightly droopy and you can tell when pictures are taken. Ive went to an eye specialist and there response is do nothing and ive asked what it is she hasand he couldnt answer my question . Im looking into a second opinion. My question to you is at whst age was he diagnosed and is he able to see? Also what effects does it cause the eye?

Jodie Ovens said...

So glad I come across this. Iv noticed my daughters left pupil larger than the right and been to the hospital to be told she will need Mri and anaesthetic! Completely petrified! I clicked on Sophia's picture as it's very similar to my little girls. It's put my mind at rest. She has very little (if any) drooping to her eye. So fingers crossed for us!