Miosis, Ptosis, and Entropion

Introduction The so-called Horner's syndrome refers to a characteristic group of ocular symptoms caused by damage to the autonomic nerves of the cervical sympathetic ganglia. This disease can occur in any part of the cervical sympathetic pathway. It is extremely rare to be caused by central nervous system lesions above the first thoracic cord. Mainly manifested as: the pupil of the affected side is reduced, the eye is cracked, the eyeball is invaginated, the face is less sweaty or sweat-free. This phenomenon is called Horner syndrome. Also known as Horner's syndrome.

Cause

The sympathetic preganglionic fibers of the eyeball originate from the C8, T1~2 segmental horn, and rise to the superior cervical ganglion via transthoracic and sympathetic trunk. After exchanging neurons, the posterior ganglia fibers pass through the internal carotid artery plexus and then pass through the ciliary The ganglia are distributed to the pupils of the great muscles, Müller muscles and blood vessels, and a small part of the sympathetic fibers reach the pupils of the pupils through the ciliary long nerves. When the sympathetic nerve lesions of one side of the eye occur, the pupil dilated muscle palsy appears, which causes the pupil to shrink, which is the main sign and the most common manifestation of this syndrome. Since the light reflection conduction path is not damaged, the pupil is reduced, but the light reaction is not changed. At the same time, due to the paralysis of the Müller muscle, the upper eyelids are slightly drooping and the eye cracks become smaller. Damage to any part of the sympathetic conduction path that governs the eye can cause Horner syndrome. However, usually the lesion of the ciliary body sympathetic center is complete Horner syndrome. The lesions of the sympathetic trunk (sympathetic chain) often only manifest as a dilated pupil.

1, unilateral contracture (small pupil reduction), eyelid drooping (small eye crack) and eyeball invagination are three characteristic symptoms of this disease.

2, visible eclipse relaxation, prominent. Sometimes half a eyeball is covered in a fixed position.

3, eyelid closure ability and pupils to maintain light resilience, but if the closure is not complete, corneal dryness can occur.

4, sick cats on the upper eyelids, blinking effort. When there is a varus due to drooping eyelids, tears are not enough. The expansion of the conjunctival blood vessels is uncertain. Time occurs, often in the afternoon or in the early hours of the morning. Drinking alcohol or nitroglycerin can trigger a headache attack. Headaches are often limited to the same side.

an examination

Related inspection

Eye and sacral area CT examination eye function examination

diagnosis:

1. Diagnosis can be made according to the three main symptoms and clinical processes of stenosis, drooping eyelids and eyeball invagination.

2. If the lesion exists on the path from the superior cervical ganglion to the eyeball, the treatment can receive satisfactory results. At this time, 1 to 2% of adrenaline is administered. If dilated sputum is seen, the lesion is located on the path from the superior cervical ganglia to the peripheral nerve (peripheral Horner's syndrome).

3. In the case of central Horner's syndrome, a small amount of norepinephrine is continuously produced by the remaining postganglionic nerve fibers, and the pupil is given 1 to 2% of adrenaline.

Auxiliary examination: examination of chest CT to exclude mediastinal lesions.

Differential diagnosis

The disease needs to be differentiated from iritis. If it is iritis, there will be special pain, iris congestion and fear of light. And Horner's syndrome does not appear these symptoms.

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