Palmer Eleanor M, Sonoo Prithvirao, Jawaid Imran, Javed Ahmed
Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, GBR.
Medicine, Nottingham University Hospitals NHS Trust, Nottingham, GBR.
Cureus. 2022 Aug 7;14(8):e27742. doi: 10.7759/cureus.27742. eCollection 2022 Aug.
The oculosympathetic chain is a three-neuron pathway responsible for sympathetic innervation to the eye, which follows a complex anatomical course through the head and neck. Neck surgery may cause injury to this pathway, causing loss of sympathetic innervation producing the eponymous Horner's syndrome (ipsilateral ptosis, miosis and anhidrosis), but this is rare in the reported literature. We present the case of a 23-year-old female who underwent total thyroidectomy for a right-sided, metastatic papillary thyroid carcinoma. Following surgery, in the immediate postoperative period, she was noted to have unilateral ptosis and miosis. This patient was assessed by an ophthalmologist due to persistent unilateral ocular symptoms following thyroidectomy. She was subsequently diagnosed with right-sided Horner's syndrome. The diagnosis was confirmed following the observed reversal of her ocular symptoms using apraclonidine 1% minims. The management of Horner's syndrome following thyroidectomy is conservative if no evidence of compressive hematoma or seroma is identified as in this case. The patient was followed up at six weeks following thyroidectomy and a partial improvement in ptosis was noted. The patient also reported blurred vision secondary to increased refractive error due to reduced pupillary function in her right eye. Prognosticating recovery from Horner's syndrome following thyroidectomy is challenging due to limited evidence. Horner's syndrome as a possible complication of thyroidectomy should be counselled to patients pre-operatively. A residual deficit from Horner's syndrome may cause functional impairment in addition to the poor cosmetic outcome.
眼交感神经链是一条由三个神经元组成的通路，负责对眼睛的交感神经支配，其在头颈部走行复杂。颈部手术可能会损伤该通路，导致交感神经支配丧失，从而产生以其命名的霍纳综合征（同侧上睑下垂、瞳孔缩小和无汗），但在已发表的文献中这种情况较为罕见。我们报告一例23岁女性，因右侧转移性甲状腺乳头状癌接受了全甲状腺切除术。术后即刻，发现她有单侧上睑下垂和瞳孔缩小。由于甲状腺切除术后单侧眼部症状持续存在，该患者由眼科医生进行了评估。随后她被诊断为右侧霍纳综合征。在使用1%阿可乐定微量液观察到其眼部症状逆转后，确诊得到证实。如果像本例一样未发现有压迫性血肿或血清肿的证据，甲状腺切除术后霍纳综合征的处理是保守的。该患者在甲状腺切除术后六周进行了随访，发现上睑下垂有部分改善。患者还报告右眼因瞳孔功能减退导致屈光不正增加而出现视力模糊。由于证据有限，预测甲状腺切除术后霍纳综合征的恢复情况具有挑战性。术前应告知患者霍纳综合征是甲状腺切除术可能的并发症。霍纳综合征的残余缺陷除了会导致外观不佳外，还可能引起功能障碍。
