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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.
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 | Figure 1.Photographs of a 50-year-old woman who underwent chemoport insertion into the left subclavian vein for chemotherapy. (A) Photograph showing 3 mm of left upper eyelid ptosis. (B) Left upper eyelid ptosis improved after instilling 1% phenylephrine. (C) At 7 months after onset, ptosis of the left upper eyelid persisted. |
 | Figure 2.Photographs of a 34-year-old woman who underwent bilateral endoscopic thoracic sympathectomy (T2– T4) for hyperhidrosis 7 months previously. (A) Photograph showing 2 mm of right upper eyelid ptosis at the first visit. (B) Right upper eyelid ptosis improved after instilling 1% phenylephrine. (C) Photograph after conjunctivomüllerectomy. The operation was performed 10 months after thoracic sympathectomy and resolved her right upper eyelid ptosis. |
Table 1.
Summary of four cases of iatrogenic Horner's syndrome
Table 2.
Results of literature review of iatrogenic Horner's syndrome
| Procedure | No. of journals | No. of patients | No. improved (%) | Duration* | No. persisted (%) | Duration† |
|---|---|---|---|---|---|---|
| Local anesthesia3–26 | 24 | 26 | 23 (89) | 5 days | 3 (11) | 15 days |
| | | | | (17 min∼9 days) | | (3 hours∼1 month) |
| Epidural anesthesia3,11–26 | 17 | 18 | 17 (95) | 5 days | 1 (5) | 3 hours |
| Subdural anesthesia4 | 1 | 2 | 2 (100) | 3 hours | 0 (0) | − |
| Lumbar sympathetic block5 | 1 | 1 | 1 (100) | 40 min | 0 (0) | − |
| Paravertebral block6 | 1 | 1 | 0 (0) | − | 1 (100) | 2day |
| Intrapleural block7 | 1 | 1 | 1 (100) | 1 day | 0 (0) | − |
| Intraoral anesthesia8 | 1 | 1 | 1 (100) | 6 hours | 0 (0) | − |
| Interscalene block9 | 1 | 1 | 0 (0) | − | 1 (100) | 1 months |
| Brachial plexus block10 | 1 | 1 | 1 (100) | 2 hours | 0 (0) | − |
| Tube thoracostomy27–31 | 5 | 5 | 3 (60) | 19 days | 2 (40) | 6.5 months |
| | | | | (8 days∼1 month) | | (6∼7 months) |
| Swan–Ganz catheter32,33 | 2 | 2 | 0 (0) | − | 2 (100) | 10.5 months |
| | | | | | | (2∼19 months) |
| Central vein catheter34–40 | 7 | 8 | 4 (50) | 2 months | 4 (50) | 2 months |
| | | | | (18 days∼3 months) | | (2 weeks∼7 months) |
| Other surgical procedure41–49 | 9 | 10 | 1 (10) | 1 day | 9 (90) | 11 months |
| | | | | | | (2∼20 months) |
| Total | 47 | 51 | 31 (62) | 1.5 months | 20 (38) | 10 months |
| | | | | (17 min∼3 months) | | (3 hours∼20 months) |
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