Claude Bernard-Horner, syndrome

Triad: ptosis, miosis and enophthalmos (or unilateral facial anhidrosis ).

This ocular sympathetic paralysis  is due to a permanent or temporary interruption of the neural pathway connecting the hypothalamus to the eye. This neural pathway includes neurons at the level of the postero-lateral nucleus of the hypothalamus linked to the cilio-spinal centre of Budge-Waller located in the spinal cord between C8 and T2. The later is connected to the superior cervical sympathetic ganglion via the stellate ganglion; the neural fibers innervating the eye and the sweat glands of the ipsilateral  lower part of the face come from the superior cervical ganglion.


The main causes of Claude Bernard-Horner syndrome can be:

-        congenital: rare 

-        compression by a benign or malignant tumor: cervical neuroblastoma, lymphoma...

-        local trauma: direct injury or compression by a hematoma following the (attempted) insertion of a catheter in the internal jugular vein

-        locoregional anesthesia: interscalenic block, block of the stellate ganglion, unilateral cephalic diffusion of an epidural block

-        compression by an apical chest drain, too close to the stellate ganglion


Anesthetic implications: 

depending on the cause: decrease the dose of local anesthetics in case of extended epidural block; check for compressive hematoma when a jugular central line has been inserted; mobilization of apical chest drain.


References : 

-         Lazar I, Cavari Y, Rosenberg E, Knyazer B. 
Horner’s syndrome in patients admitted to the paediatric intensive care unit: epidemiology, diagnosis and clinical practice. 
Anaesth Intensive Care 2013; 41: 20-3.

-        Aronson LA, Parker GC, Valley R, Norfleet EA. 
Acute Horner syndrome due to thoracic epidural analgesia in a paediatric patient. 
Paediatr Anaesth 2000; 10: 89-91.


Updated: October 2019