There are few things more satisfying than diagnosing Horner’s Syndrome on a ward round — unless, of course, you’ve just drawn the perfect ABG on the first try. 😉
In my time rotating through the General Medicine and CCU departments at Sheikh Khalifa Bin Zayed Hospital, I’ve seen Horner’s sneak up in all kinds of cases — from Pancoast tumors to carotid dissections. Subtle signs, big implications.
Let’s make it stick with a classic mnemonic to remember the components of Horner’s Syndrome: SAMPLE 🧠
Mnemonic Table: Horner’s Syndrome — “SAMPLE”
| Letter | Feature | Explanation |
|---|---|---|
| S | Sympathetic chain injury | The root cause — interruption anywhere from hypothalamus to eye. 🧬🛑 |
| A | Anhidrosis | Loss of sweating on the affected side of the face. Dry and not in a good way. 💦🚫 |
| M | Miosis | Constricted pupil due to unopposed parasympathetic tone. Pupillary politics. 👁️📉 |
| P | Ptosis | Droopy eyelid thanks to Müller’s muscle losing its sympathetic support. 💤👁️ |
| L | Loss of ciliospinal reflex | Normally, pinching the neck dilates the pupil. Here? Nothing. The pupil just stares at you. 😐📎 |
| E | Enophthalmos | Sunken eyeball — though more often perceived than real. Optical illusion 101. 🎩🔍 |
🩺 My Clinical Take (Straight from Quetta)
I remember a young man with neck trauma post-road accident — normal CT brain, no visual complaints, but the left pupil was noticeably smaller with mild ptosis. That moment when your med student says, “Sir, I think it’s Horner’s,” and you don’t need coffee for the next 6 hours.
We traced it back to a carotid dissection — caught early, managed well. Moral of the story? Always check the eyes. The ANS never lies.
🧠 Clinical Tips
- Horner’s is often missed because it’s not dramatic. Look for subtle ptosis and miosis, especially in neck trauma, apical lung tumors, or surgical patients post-neck dissection.
- If you’re still not sure, instill apraclonidine — it reverses the anisocoria in Horner’s. Like pharmacologic magic. 💧
HAPPY LEARNING, folks! 🙂
Signing off,
Dr. Aurangzaib Qambrani
(MBBS, PLAB, MRCP-UK 1)
Sheikh Khalifa Bin Zayed Hospital Quetta
