Iatrogenic Horner's Syndrome After Procedure in the Neck and Upper Thoracic Area.

Jo, Young Joon; Lee, Yeon Hee; Yun, Yong Jun; Lee, Sung Bok

doi:2009.50.6.809

J Korean Ophthalmol Soc > Volume 50(6); 2009 > Article

Original Article

Journal of the Korean Ophthalmological Society 2009;50(6):809-815.
DOI: https://doi.org/10.3341/jkos.2009.50.6.809 Published online June 15, 2009.

Iatrogenic Horner's Syndrome After Procedure in the Neck and Upper Thoracic Area.

Young Joon Jo, Yeon Hee Lee, Yong Jun Yun, Sung Bok Lee

¹Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea. sblee@cnu.ac.kr
²Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea.

경부 및 상부흉곽 술기 후 발생한 의인성 호르너증후군

조영준^1,2ㆍ이연희^1,2ㆍ윤용준¹ㆍ이성복^1,2

Department of Ophthalmology, Chungnam National University College of Medicine¹, Daejeon, Korea / Research Institute for Medical Science, Chungnam National University College of Medicine², Daejeon, Korea

Abstract

PURPOSE
To investigate the natural course of iatrogenic Horner's syndrome induced by procedures in the neck and upper thoracic areas. METHODS: Four patients who developed ptosis after undergoing procedures near the neck and upper thoracic areas were diagnosed with iatrogenic Horner's syndrome. We evaluated the clinical courses of the patients retrospectively. We also performed a systematic Medline search through Pubmed to find patients with iatrogenic Horner's syndrome. We summarized onset times and natural courses of reported cases. RESULTS: In two cases, ptosis improved completely within 2 and 4 months. In the other two cases, ptosis persisted through the last follow-up. As a result of our Medline search, we identified 51 cases in 47 journals. In 31 patients (62%), symptoms improved from 17 minutes to 3 months after surgery. However, in 20 patients (38%), symptoms persisted for up to 20 months. CONCLUSIONS: Although the mechanism underlying iatrogenic Horner's syndrome induced by procedures in the neck and upper thoracic area is not clearly understood, the syndrome may occur when the sympathetic nerve pathway is damaged directly or indirectly. Surgical correction should be postponed because this rare complication may resolve spontaneously within 4 months. The surgeon should explain the possibility of Horner's syndrome to patients after neck and upper thoracic surgery.

Key Words: Catheterization;Horner's syndrome;Iatrogenic;Ptosis;Stellate ganglion