Vet Guide 2025: Horner's Syndrome in Dogs and Cats 🐶🐱👁️

Hello pet parents! I’m Dr Duncan Houston, here to guide you through Horner’s Syndrome in dogs and cats. In this detailed 2025 guide, we’ll cover what it is, how it happens, what symptoms to look for, methods of diagnosis, and how to support your pet’s recovery. With clarity, care, and compassion, I’ll help you protect your furry family! 😊

What Is Horner’s Syndrome?

Horner’s Syndrome isn’t one disease—it’s a set of five signs caused by disruption of the sympathetic nerves supplying the eye and face:

• Constricted pupil (miosis)
• Elevated third eyelid
• Retraction of the eyeball (enophthalmos)
• Drooping eyelid (ptosis)
• Increased warmth/redness of ear and nose on the affected side

These signs appear on the side with sympathetic nerve damage. Often not painful or vision-impairing, the syndrome signals an underlying issue that should be investigated.

The Sympathetic Nervous System Pathway 🧠

The sympathetic nerves originate in the brain’s hypothalamus, travel down through the brainstem and spinal cord, exit in the chest, go up through the neck, pass near the ear, and enter the eye. Any damage along this path—central, preganglionic, or postganglionic—can result in Horner’s Syndrome.

First-Order (Central) Lesions

Involve damage to the brain, brainstem, or spinal cord (C1–T2). Causes include:

• Brain tumors or strokes
• Spinal cord disc herniation or embolism
• Trauma to the neck or vertebrae

Signs may include other neurological deficits. MRI is often recommended to localize the lesion.

Second-Order (Preganglionic) Lesions

Damage between spinal cord exit and the sympathetic chain in the chest and neck (T1–T3). Causes include:

• Trauma—especially forceful forelimb pulls
• Chest masses affecting nerve pathways
• Neck injuries from collars or accidents

Chest imaging (X-ray, CT) is indicated if history or exam suggests central or chest involvement.

Third-Order (Postganglionic) Lesions

Most common in small animals. Impact the nerves between ear and eye. Causes include:

• Middle or inner ear infections
• Vestibular disease and head tilt secondary to ear issues
• Tumors or inflammation near the base of the skull

An ear exam—including otoscopy and imaging—helps identify the source.

Recognizing Symptoms in Pets

Signs develop on one side of the face. Look for:

• Smaller pupil on the affected side
• Visible third eyelid protruding
• The eye appearing sunken into the socket
• Droopy eyelid lid margin
• Facial flushing or warmth (harder to detect)

These signs often appear suddenly, and may be accompanied by signs of ear disease, neck pain, or other neurological symptoms.

How We Diagnose It

Medical History & Physical Exam

• Onset, side affected, trauma, ear disease history
• Complete neurological exam to identify other deficits
• Otoscopic evaluation to inspect ear canal and eardrum
• Fundic exam to verify pupil size and light response

Pharmacological Testing

Eye drops—like phenylephrine—can help localize the damage. A quick pupil dilation response suggests a postganglionic lesion.

Imaging Studies

• MRI: Ideal for brain and spinal evaluation
• CT/X‑rays: Useful for chest masses, neck injuries
• Ear imaging: Highlights middle ear lesions, inflammation, or tumors

Treatment & Management 🩺

Treating the Underlying Cause

• Ear infections: Antibiotics or antifungals guided by culture
• Cervical/chest masses: Biopsy, surgery, or oncological treatment
• Spinal cord or brain lesions: Managed via surgery, steroids, or neurology referral

Supportive & Cosmetic Care

While Horner’s Syndrome itself is harmless, cosmetic management includes:

• Phenylephrine eye drops: Temporarily relieve ptosis and pupil constriction
• Supportive eye care—hydration, lubrication if blinking reflex is reduced

Monitoring & Prognosis

• Idiopathic cases: Many resolve spontaneously within weeks
• Post-infection/injury: Symptoms may improve as the body heals
• Cranial/spinal nerve damage: Prognosis depends on the extent—may require ongoing management

Home Care & Observation

• Keep eyes clean; use warm compresses if discharge occurs
• Administer eye medication as directed
• Monitor both eyes for worsening signs
• Provide a calm environment and follow vet’s treatment plan closely
• Schedule follow-up for recheck exams and imaging if needed

Frequently Asked Questions

Is Horner’s painful for pets?

No—except when associated with painful ear or spinal disease.

Will the eye look normal again?

Often, yes—especially in idiopathic or infection-related cases. Cosmetic drops help during recovery.

Should my pet see a neurologist?

If MRI reveals brain/spinal involvement, a neurology referral is highly recommended.

Can ear cleaning help?

Yes—treating underlying ear infection often improves or resolves the syndrome.

Is Horner’s permanent?

Only if the nerve damage is severe or chronic (e.g. tumor or trauma). Otherwise, many pets fully recover.

Conclusion

Horner’s Syndrome is a striking yet non-painful set of signs that signal nerve damage. Recognizing the syndrome and localizing the source of the problem helps guide diagnosis and treatment. With proper veterinary care—especially addressing ear or neurological causes—many pets fully recover.

For guidance, specialized diagnostics, or compassionate support, visit Ask A Vet or download our app. We’re available 24/7 to help you understand the condition, carry out treatment plans, and watch your pet’s recovery. 🐾📱

Dr Duncan Houston, BVSc