Re: Horner's Syndrome and MS?

Posted By CCF Neurology M.D. on February 10, 1998 at 09:47:08:

In Reply to: Horner's Syndrome and MS? posted by Barbara on February 10, 1998 at 08:42:33:







: I have a diagnosis of probable MS over the last 6 years (following a positive MRI and continuing mild clinical signs).  A problem for which I have found no explanation is a "shadow" affecting my left eye.  At least two times, several years apart, the left eyelid drooped about 1/2 way down for a few weeks and then went back to normal, but this "shadow" has been a fairly constant companion over the last 6 years beginning just before the neuro problems that led to my original workup for MS.  I may not notice it for a while, but if I am overheated, using my eyes in a stressful way - such as looking at a pc monitor for long periods - it is very prominent and a real nuisance.  Two opthalmologists over those years have performed only cursory exams and declared that even though they saw no sign of ON, it must be related to a ON attack at some time.  The exams were both so short (eyes not dilated, etc. - one exam lasted only about 1 minute), that I believe the probable MS dx was the sole source of the diagnosis.  I should say there has been no loss of vision in that eye - no blurring or field deficit - only this sensation of less light in that eye and possibly a slight feeling that the left eye has trouble "catching up" with the right.
I have recently read about "Horner syndrome" which I understand causes the pupil to remain restricted and might also cause the eyelid to droop.  Could all this be related to MS?  (My understanding is that Horner's is due to a problem in the sympathetic nervous system - as distinct from central?)  Is Horner syndrome a realistic possibility?  And if so, is there anything that can be done for it?
Thank you for your response.   Even though this is not disabling, it is very distracting and I would like to know if anything might be done to help it.
Dear Barbara,
Horners syndrome is classically described as ptosis (droop eye lid), miosis (small pupil), and anhydrosis (lack of sweating on one half of the face). Although not typically described as a feature of multiple sclerosis, after reviewing current literature, a few cases have been documented. The described an incomplete Horners, that is, not showing all but some of the symptoms.  The visual "shadow" that you describe is probably not related to the horners, and is more likely due to optic neuritis. I would recommend that you get a good neuropthamology exam.  If you have not had visual evoked potentials performed, it may be another test that may provide valuable information.  Uptoffs phenomena is seen in patients with MS, that is, that symptoms tend to worsen when a person is overheated.  This probably explains your eye droop worsening when you arre overheated.  If you are interested in getting an appointment at CCF with a neuroopthomologist (Dr. Kosmorsky) call 1-800-CCF-CARE.