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Sunday, July 8, 2007

Horner's syndrome

So, littered streets and consumption-junction (Toronto's public transit) irritate me. Now you know.
Back to veterinary medicine. A big, friendly, middle-aged, black lab was presented to me the other day with an "eye problem."
Indeed his left eye was affected but the problem was not of the eye per se, but rather of the sympathetic innervation to the
eye(s).
Heh?
Let me illustrate: If I scared the s--t out of you, your sympathetic nervous system would kick in. Your heart would start to race, your blood vessels in your muscles dilate to allow more oxygen to reach them, your eyes pop out a little, your eyes (lids) are wide open, and your pupils are dilated - all for "fight or flight."
Forgetting all but the eyes, Horner's syndrome involves a disruption of the sympathetic innervation to the eye(s). So what ensues? This dog had a droopy eyelid, a constricted (or miotic) pupil, a sunken eyeball and a mildly-protruded third eyelid (we don't have that one).
Ok, that was the easy part. A syndrome is not a disease but rather a constellation of clinical symptoms that results from a disease. My job is to find out what is causing this dog's Horner's syndrome.
Many of these cases are idiopathic. That is to say, there is no discernible cause to the disease. Most resolve by themselves. This is somewhat comforting. Another important place to look is the middle ear, through which a portion of the sympathetic branch runs. Dogs with a middle ear infection often have Horner's syndrome. Other causes include spinal diseases such as a "pinched nerve" from a disk, or a spinal tumor. Even hypothyroidism (low thyroid function) can cause Horner's. This guy's thyroid is normal. So far, it looks idiopathic as I cannot find a cause. I took x-rays of the tiny spherical bones at the base of the skull (called tympanic bullae) as these may show evidence of a middle infection. I've sent those radiographs to be interpreted by a specialist in radiology.
The good news is that this dog has no clue he has Horner's. He's happy as a clam.

A cat with Horner's syndrome. Note the third eyelid protruding (the cat's right eye).

158 comments:

Naruto Fan said...

we have a cat that looks like that, his name is orb, and the reason for his name is because he has two different color eyes. If you know why please comment back because I'll be looking out for it ^.^

TORONTOVET said...

Naruto,

If you look carefully, it's not the same thing as what you're seeing in your cat. Cats, dogs, and some other animals have a THIRD eyelid, which is what the white thing covering the cat's right eye is in this photo.

In response to your great question regarding eye colour: In simple terms, it's all due to genetics. Copy and paste the following for more details:
http://ask.yahoo.com/20020724.html
Thanks for the comment!

Anonymous said...

We have two 12 year old collies and a new 5m mix puppy. Both collies have Horner's syndrome. The most active female got it first then the more sedate collie second. Our vet thinks it's due to a sudden change in activity level. I think it is unusual to have both dogs affected within weeks of each other without an infectious cause. What do you think?

TorontoVet said...

Dear Anon,

This is indeed strange. If this is TRUE Horner's syndrome, these cases are often idiopathic (no discernible cause). This may be highly odd and coincidental for two of your dogs to have it, but not impossible. Remember, these dogs are both geriatric, and Horner's syndrome is not uncommon.

However, we need to rule out other causes first. Thorough deep otoscopy (ear exams) on both dogs are mandatory to rule out infections of the middle ear. Normal otoscopy does not preclude middle ear infections. X-rays or MRI of the bullae (spherical bones at the base of the ears) may reveal the presence of infection here.

Routine blood tests (CBC/Chemistries and thyroid profiles should be done on both dogs, especially if their energy levels have decreased significantly.
Hypothyroidism is a possible cause of Horner's syndrome in dogs. Lastly, x-rays of the dogs' chests should be done as thoracic or spinal tumors can cause Horner's syndrome due to a portion of the sympathetic branch that runs to the T1-T3 verterbrae.
I hate to say it but I'd really like to examine these two dogs. Besides the Horner's, how are they doing otherwise? Great? Lethargic? Losing weight? Other symptoms? I would also highly recommend a referral to a neurologist if your vet does not pursue this further.
Good luck and please keep me posted.

tricia11 said...

Hi there--

I have a 7 year old bloodhound mix named Buster. He has presented with classic Horners: protruding third eyelid and sunken eyeball. At the same time he is exhibiting other behavioral and clinical symptoms including: refusal to eat his normal dry dog food, vomiting (precipatated by eating grass), being more "clingy and needy" with me (which welcome of course). He has lost 7 pounds in 3 weeks. His temperature is normal as is his blood chemistry (still awaiting the thryroid results). My vet found that he is missing his eardrum on the affected side but there is no sign of infection. When he does eat his normal dry food it often falls out of his mouth. My vet believes that he simply has Horners--which I hope is the case--but I am nervous that he could have a tumor or an abscess or something. Do you have any advice that you could share with me. I am scheduling him for a skull and chest this Friday assuming I can get an appointment. Thank you for any and all assistance.

Tricia

TorontoVet said...

Tricia,

Have a look at your dog head on: is there a droopy lip? Does it look like he's "smiling" on one side of his face? Touch his eyelid - can he blink on both sides? Is his nose deviated away from side affected with Horner's? Along with these signs, a very important clue you gave me that cannot be discounted is that food falls out of your dog's mouth when he eats. This is highly suspicious of facial paralysis. This is caused by a problem affecting the 7th cranial nerve, which courses in the middle ear, next to the affected sympathetic branch, likely responsible for the Horner's. With a ruptured ear drum on the affected side, Horner's syndrome, and facial paralysis, I am highly suspicious of a middle ear infection (otitis media). This may even be bilateral so make sure we look deep down in both ears. Another possibility is a growth in the middle ear.
My recommendation is to have the bullae x-rayed. Those are the little bones that house the middle ear. Your vet should be familiar with how to obtain those x-rays. Very importantly, if the x-rays are normal, I'd pursue an MRI or CT scan of the skull as plain x-rays are not very sensitive - meaning they might "miss" the problem. Please keep me posted.

TorontoVet said...

Tricia,

Let me add: all the signs (including nausea/vomiting) may be attributed to a problem within the middle ear.
Let's see what his thyroid results are, but hypothyroidism doesn't result in a ruptured ear drum.

Anonymous said...

In response to the Apr 18/08 post about Horners in two 12 year old collies. My 9 year old collie experienced Horners last Fall and after undergoing several tests, we determined it was idopathic and indeed, it went away on its own a few months later. Now, a couple of days ago, she seems to show symptoms of Horners again - strange that it's come back same time of the year (late Fall). But I've been trying to figure out what's been different in the past 2 days that may have brought it back. One thing occured to me -- because collies tend to be barkers, when we let her out in the backyard we put an electronic anti-bark collar on her(and have since she was about 2). Recently, it had been quite loose around her neck and about 2 days ago we tightened it. I'm wondering if the tighter collar could have been responsible for the recurrence. We've now loosened the collar again, but if it's same as last year, I expect it may take a few months to go away. So when I read the post about the person with the 2 collies, I wonder if they also use an anti-bark collar or choke collar on their dogs and if this could be a cause?

TorontoVet said...

Dear Anon,

I don't believe the issue is related to the collar. I think the tightening of the collar is a coincidence. The sympathetic branch that is affected in Horner's syndrome courses deeply so superficial trauma would not result in the nerve being affected. Are you sure this is true Horner's: droopy eyelid, small pupil, protruding third eyelid, and possibly sunken eyeball?
Though the first episode was believed to be idiopathic, it does not mean it is this time. I think the ears need to be examined (down to the eardrum and at least x-rays of the bullae should be performed, perhaps even an MRI.
Lastly, I'd run a thyroid profile on your dog. It's rare but sometimes hypothyroidism can cause these "funky", focal, neuro issues.
Can your vet refer you to a neurologist?

Roberta said...

I have a golden retreiver, 11 years old with Horners syndrome from a middle ear infection. She is being treated with oral antibiotics and antibiotic ear drops. It has been three days and her rt eye still looks bad. My concern is, will the rt eye dry out and should i be putting drops in or does the third eye lid protect the cornea from drying out? No one seems to mention it so I assume that the vet would have suggested it. Thanks for your input.
A concerned "parent".

TorontoVet said...

Roberta,

It may take weeks or even months for the Horner's to resolve. There is even a possibility that it will not completely resolve. However, most cases I've dealt with have become normal over time.
Do not worry about the eye drying out. Not only will the third eyelid (or nictitans) keep the cornea moist, but so will the "regular" upper and lower lids with normal blinking.
Thanks for reading and posting your comment. Happy New Year.

Larissa said...

I have a 7 year old Great Pyrenees with what I believe to be Horner's. He's exhibiting the classic droopy lower eye lid, sunken eyeball, dilated pupil and raised third eye lid. It came suddenly about a week ago and looks pitiful. My other Pyr, his litter mate brother, displayed the same thing about 4 1/2 years ago, which did alleviate with time, despite a couple of unhelpful vet visits. Could this syndrome be genetic? And, is there any treatment which would help it heal sooner? What are the odds of it never fully returning to normal? Thanks for the info.

TorontoVet said...

Larissa,

Thanks for your patience. I believe you meant a small or miotic pupil, right? A dilated pupil is not consistent with Horner's.
Cases of Horner's syndrome should be worked up. A diagnosis of idiopathic Horner syndrome can be made if other diseases have been ruled out first.
His ears should be thoroughly examined, possibly including imaging like x-rays or even an MRI (because the middle ear needs to be evaluated), a full thyroid panel, and in a large breed dog, I would also recommend thoracic radiographs as the sympathetic branch runs along the spine down to around T2-T3. Chest tumors can cause Horner's syndrome, too.
Most dogs with idiopathic Horner's improve dramatically with time but it may take a few months. Sorry, I don't have statistics for you.
Take care!

Anonymous said...

I have a 6 year old Golden Retriever that was diagnosed with Horners. They looked in her ear and saw no infection. They also wanted to run a bunch of blood tests and xrays to rule out all of the things I have seen listed here. We could not afford them so we went with the wait and see approach. Now her face looks... strange.Instead of drooping, it has now pulled back to the point where her nose is actually crooked! Her face looks and feels "dead" on that side. I thought it was atrophy of the muscles possibly? But it is getting worse. Gone is the drooling and the eye problems...but she looks llike her face can't stretch much farther. I am just wondering if this is normal with a dog that has horners? She has had it for at least 4 months now. Thanks.

TorontoVet said...

Dear anonymous,

A huge percentage of dogs with facial paralysis have idiopathic disease: no identifiable cause could be found.
However, in this case, I would be suspicious of a middle ear infection (if the facial paralysis is affecting the same side as the Horner's). The facial nerve (7th cranial nerve) courses in the middle ear, along with the sympathetic branch (which is affected in Horner's syndrome).
There may be no external evidence of infection with middle ear infections.
Without further testing, I would recommend a course of antibiotics for at least 2 months. Given the fact that this has been going on for some time, I would expect to see changes in the bullae (the middle ear) on plain x-rays. Try to have at least those done.
Good luck.

Anonymous said...

I have an 8 year old dog that got horners just a couple days ago she is a beagle bluetick mix she had two of those symptoms droopy eyelid and potruded third eyelid what i dont get is that it went away that quick so I'm kind of wondering if it goes away in 2 days.

Anonymous said...

My 11 year old cocker spaniel injured his left shoulder about 10 months ago. After surgery and a couple of months of recovery, he was back to his old self. Then about a month ago, he stopped using his left front leg again. At about the same time, he developed Horner's syndrome. The surgeon went back in to the shoulder and removed a couple of anchors, but 2 weeks later he still is putting no weight on the leg. A different vet removed the sutures and noticed the Horner's syndrome, and wonders whether a tumor could be causing both problems. He recommends a neurological exam. Comments?

TorontoVet said...

Anon 1: If it disappeared after 2 days, I wouldn't worry too much about it.

Anon 2: Lameness and Horner's syndrome would indicate a lesion at the T1-T2 spinal segment. Possibilities include 1) tumor (especially of the nerve sheath), 2) infection/diskospondylitis and 3) protruded disc, but disc don't usually protrude ventrally to affect the sympathetic branch which causes Horner's. I think a consultation with a neurologist would be best. I'm sorry about jumping the gun, but you may want to read this article:
http://www.petmd.com/dog/conditions/neurological/c_multi_schwannoma
Keep me posted and best of luck.

Anonymous said...

Hi, several weeks ago I noticed my 2 year old golden had an ear infection. We took her in and she was treated with medicine for a yeast infection. We used the medicine in her ear until it ran out and thought the infection was gone. Her ear started bothering her again and last week we took her back. The infection was back and she was treated with more medicine, but a different kind? Yesterday I noticed her eye was saggy and admormal looking so I took her in this morning and just learned she has Horner's disease. The doctor said her eardrum ruptured and that we will have to change the medicine she has currently been on, yet again. When i googled Horner's, I noticed one of the causes was treatment, or medicine. What i am wondering, is if the doctor could have caused this with an incorrect treatment of the ear. He told me he didn't think blood work was necessary, but wouldn't blood work determine what the cause of the Horner's was? Please help!!

TorontoVet said...

Hi Anon,

We know by default that the Horner's MUST be caused by a middle ear infection given the clues you are giving me (history of otitis, ruptured ear drum, etc). Bloodwork won't tell you much in this case, especially in a young, healthy Golden.
I would strongly recommend one of two things: either 1) a middle ear flush and bacterial culture with the dog under general anesthesia - to see what antibiotic (or antifungal) is the most appropriate or 2) a bulla osteotomy with a middle ear flush and culture. I think the latter would be most appropriate so that the infection may drain. The presence of yeast in the outer ear does not mean the middle ear infection is caused by yeast!
I would much prefer choosing a medication based on the results of a bacterial culture of the middle ear, rather than choosing willy nilly. Your dog needs oral medication, an ear flush that is not ototoxic (no propylene glycol), and a topical medication.
The topical medication didn't cause this. An infection did. Best of luck.

Anonymous said...

Good evening! My 12 year old lab was just diagnosed with Horner's Syndrome on Monday. We did xrays and ruled out any sort of masses and he had a full set of blood work done just about a month ago, so the vet felt confident that it is either idiopathic at this point or ear related. When she vet went to check his ears he was quite sensitive so she just did a swab test to determine that he had a yeast infection. She put him on some ear drops and said that I should get his ears rechecked again in 2 weeks after the infection clears up. However, as I've been putting in the drops I've noticed some "growth like" bumps in his right ear. I'm guessing that is related to the Horner's but should I take him back to the vet right away or wait the full 2 weeks to get him checke again? And what might the bumps be? Thank you!

TorontoVet said...

Thanks for the post. The swab only determined that the dog has otitis externa (the ear canals). This may not correlate with the Horner's. Ear drops may clear the yeast but not the Horner's.
The deep ear needs to be examined while the dog is heavily sedated or under general anesthesia in order to evaluate the integrity of the ear drum. The ear needs to be flushed out and a culture of the MIDDLE ear needs to be done.
I don't know what these lumps are but you should show them to your vet right away.
That said, you have a greater reason to sedate the dog and flush the ear: these masses need to be biopsied. I would show these lumps to your vet right away.
Due to the nature of this problem and your dog's age, I would actually recommend a MRI or CT scan of the middle ears as x-rays are extremely insensitive at picking up problems in the middle ears. The MRI or CT will far likely be diagnostic (even if normal). Best of luck.

Anonymous said...

I have a 4 month old Weimaraner who all of a sudden has the symptoms opf Horner's. I am wondering if this could be caused from getting water in his ear from a bath the day before?

Anonymous said...

I have a 4 month old weimaraner who is showing the signs of horners. I was wondering if this could have been caused by water getting into the ear from a bath the previous day?

Anonymous said...

I just wrote in about a weimaraner and forgot to include that the symptoms....droopy eye, third eyelid, and sunkin look come and go. One minute he will be ok looking and then the next they eye looks terrible.

TorontoVet said...

Dear Anon,

It's likely not from the water that got into his ear.
His eardrum would need to be ruptured and this occurs only with trauma or a severe infection. Horner's syndrome occurs with problems within the MIDDLE ear.
An infection is possible. Neospora is also possible but would likely also cause other neurological symptoms like weakness, ataxia, and seizures.
Trauma is also possible, especially since we have a little rambunctious puppy.
This should resolve by itself in a week or so. If it doesn't, he needs to be examined.
Thanks for the comment.

kat said...

Hi,
Ive been reading the posts and my dog has many of the same symptoms others describe but has a dilated pupil rather than constricted. We went to the vet and she referred us to an opthalmologist. My dog, Bear, is a 9 y/o golden/irish setter mix. About two weeks ago I thought he had an ear infection but it went away in a day or two and he seemed fine. Now his eye, droopy lid, third eye protruding but dilated pupil. He also has arthritis, thyroid condition and is an amazing guy. What are your thoughts please. Thanks so much,
kat

Anonymous said...

Can Horner's cause vision change/loss? My Siberian Husky puppy was diagnosed with Horner's 3 weeks ago. Vet is treating him for ear infection though no tests were done to determine this is the cause. He's been on prednisone and cephalexin 500mg (oral b.i.d.). The eye symptoms went away after 1st day of med, but come back sporadically. The color of his eye has changed from blue to gray and he seems to have trouble seeing his tennis ball when I throw it.

lori said...

I have a standard poodle with Horner's. It happened 2 yrs. ago. I took her to my vet, who diagnosed this "as it looks like Horner's" and then I took her for a second opinion, who definitely diagnosed it as Horner's. Both of them said that there is really nothing to do for it. They placed a dye in her eye to see if there were any foreign objects. There was something in her eye. They gave her an antibiotic and drops. Several weeks later, I took her back and they placed a dye in her eye to see if the objects were gone. She was fine. However the eye hasn't gotten any worse or better. The vets tell me she's not in any pain. I just don't like the way it looks and I don't like the tearing.

TorontoVet said...

Kat, Anon, Lori,

A dilated pupil is not caused by Horner's. Things like glaucoma, iris atrophy (not true dilatation), and other eye and neuro problems can be the problem.
Horner's does not cause vision loss. This would concern me more and should definitely be seen by an ophthalmologist.
Lori, has anyone closely looked for an ectopic cilia? This is a hair/cilia that grows on the inside of the lid and may cause squinting, tearing, and a prolapsed 3rd eyelid - not true Horner's. It's sometimes hard to find, but can usually be found with patience and a good light source!

Anonymous said...

My Rhodesian Ridgeback, 10 days ago became paralyzed, and unable to eat or drink. Since, he has come home from the vet and been on my living room floor for 5 days. He is able to eat and drink liquids through a syringe. He has horners symptoms and has very little use of his muscles. He is starting to move and turn more. I have been thinking this was canine vestibular syndrome until the horners showed up. Could this be both? I am truly at a loss as I don't know what to do, because he is showing improvement. I know both can be a cause of inner ear infection. Your advice PLEASE.

Anonymous said...

Hello,
My dog is a 3 year old golden doodle, started getting the Horners in her left eye early January. I was told to wait and see for improvement. She had a ear infection (has been re-occurring over the years) but in the right ear. It was treated however the syndrome was still there in the left eye. Now she has developed the syndrome in both eyes, does it make the cause more specific? She does shake her head often and is somewhat less active in the house but outside she is still playing like a puppy! We are on a waiting list to see a neurologist.

Anonymous said...

Last Monday, I brought my 12 year old yellow lab to the vet with a droopy right eye. She diagnosed Horner's Syndrome. My lab has multiple tumors on her skin, one on her back spine area, fatty tumors the size of marbles and wart looking skin tumors. I took her for a walk on Sunday, less than 10 minutes and she seemed to be staggering. She also struggled with completing the walk. Yet, she's excited, wags her tail, bounces all over the place when I come home and still has a lot of energy. Then just 9 days after her last visit, she's now got the same problem on with the other eye. She doesn't appear to be in pain as she's still a bouncing yellow lab. The vet told me to take her home, love her and let her life a comfortable life. She's already had multiple surgeries and just undergoing an MRI to see if she has a brain tumor potentially could kill her. I'm devastated. Have you ever seen this happen in both eyes within 10 days of each other? Seems like there is a real cause for this and not just a fluke.

TorontoVet said...

Dear Anon,

I'm sorry you're going through this now. Bilateral Horner's syndrome and staggering (called ataxia) strongly points to a problem at the T1-T3 area of the spine. Based on her age, this could be a tumor, especially a nerve-sheath tumor. But it could be other things, too. She needs an MRI of that area of her spine for a definitive diagnosis, and chest x-rays, too. Good luck

-TorontoVet

kat said...

Hi anon,
this is in response to the person with the yellow lab with droopy eyes. We had a similar incident and went through a bunch of testing. Definatley get a chest xray and they will recommend the rest. Our dog presented with similiar issues but only on one side. I hate to say but my dog does not have a good prognosis but maybe you can catch it early and that would be good. all the best to you. k

kat said...

Hi Anon,
We had a similar problem with the droopy eye but only on one side. We ended up with much testing and finally after seeing a neurologist who did a chest x-ray did we get on the right track. I have to say, sadly, my doggies prognosis is not good however, if this saves you some time you may get to it earlier. All the best and if you need any information Im happy to help.
the best,
k

Anonymous said...

Hi TorontoVet,
Thanks for the information on my 12 year old yellow lab. The skin tumor on her spine is farther towards her tail so it's not the one I feared. However, my vet told me that since she's 12, putting her under for an MRI could potentially kill her. Then if we did find a tumor, what would we be able to do given her age? She told me to take her home, she's a happy old yellow lab and keep loving her. So if I do that, when will I know if she's in pain? When I took her for a walk and a strange dog darted out from a neighbors yard and scared her, did that cause the second eye to go into Horner's. It happened that evening and I'm feeling guilty for walking her now. Thanks again for all your help with this topic. This is a very sad and difficult time for me and my sons.

TorontoVet said...

Anon,

You did nothing to cause the Horner's, so please don't feel guilty. At this point, let her do whatever she wants, and can, do.
If she's stumbling or weak, though, just make sure you're careful on stairs, getitng into the car, etc, etc. Just use common sense.
You will know before all others when it's time to say goodbye. Now is not that time.
Take care.

Cory said...

Our 3 1/3-year-old German shepherd mix was diagnosed today with Horner's. He also recently (within the last month) began having seizures whose cause has not been determined. He is now on phenylbarbital.

Is there one underlying condition that could cause both Horner's and seizures? We are planning to take him to the neurologist next week, but I would like to prepare myself in case it could be something like a tumor causing both.

Thanks in advance for any insight you can offer.

TorontoVet said...

Cory,

Sorry to hear...
This is the appropriate age for Shepherds to first start showing signs of idiopathic epilepsy (epilepsy with no underlying cause).
The Horner's could have occurred from a hematoma while the dog was seizing, but that is just a theory for now.
If the Horner's goes away, my first bet is idiopathic epilepsy. If it gets worse, there could be a tumor there or even an infection, such as from a tick-borne organism (Lyme disease, Ehrlichiosis, Rocky Mountain Spotted Fever, etc.).
I'm glad you have the appt with the neurologist.
By the way, phenobarbital is no longer the 1st choice of drugs in dogs - discuss other options, like potassium bromide, Keppra, and others.
Please keep me posted after your visit and good luck.

Cory said...

Thanks for replying to my earlier post. I believe our vet may have misdiagnosed him, however. In the material about Horner's that she sent home with us, it says Horner's does not cause pain or vision loss. He is definitely uncomfortable and possibly in pain, periodically "rubbing" that eye with his paw, and he is experiencing vision problems in that eye. It's most evident when he drinks water -- his depth perception seems to be off. He is also very easily startled when you come up to him on that side, and he is favoring that side of his face. Is it possible that other diseases (possibly one that also causes seizures) can mimic the presentation symptoms of Horner's? His eye is red, and his eyelid is covering the bottom half of his eye. His eye does resemble that of the cat in the photo on your blog.

I realize that you can't diagnose him via blog, but I'm just wondering if it could be something else. We are starting to get very concerned about that eye. He is shying away from drinking and eating, we think because he cannot see properly. He will drink and eat if you bring the bowl up to him or feed him out of your hand.

Thanks in advance for any ideas you have. Again, not asking for a diagnosis or advice, but just ideas. (Our vet does not work on the weekend, so the earliest we can reach her is Monday morning.)

Cory said...

I should add that he is extremely lethargic, but we were told that is normal with phenolbarbital until a dog's body adjusts to it.

TorontoVet said...

Cory,

That's important info, thank you. This changes things.
The vet may have diagnosed Horner's syndrome based on the small size of the pupil. This however is only ONE component of Horner's and must be accompanied by other signs like a droopy eyelid, possibly a sunken eyeball, and certainly a prolapsed third eyelid (you may call the "flap" or pink eyelid in the eye. You describe the last symptom but are there others?
OK, now on to the important stuff: I can't be sure because I haven't seen him but I don't think he has Horner's. It sounds more like he's got a uveitis (if his pupil is smaller on the affected side - is it?),
Uveitis coupled with seizures rings very loud bells for an infectious cause for both. The list is long: leptospirosis, Ehrlichiosis, other Rickettsial diseases (tick-borne diseases), fungal (meningo-)encephalitis, canine distemper virus, ocular larva migrans, etc, etc. All of these can cause uveitis, vision loss, and seizures.
I'm hoping you can see a neurologist soon. He'll likely require a tick and fungal "panel" (simply a blood test that measures antibody titers for a panoply of fungal and tick-borne diseases. A CSF tap may also be very helpful. This is an examination and analysis of the fluid surrounding the brain. Imaging such as MRI or CT may also be helpful.
Thank you for adding that info to the history. You can see how important it is.
Having said all of this, I have NOT examined your dog so this is all speculation. Your dog MUST be seen by a neurologist.
Please keep me updated and good luck.

Cory said...

You asked for an update once we'd seen a neurologist. An MRI revealed that he has a large mass in his brain, probably a tumor (5% chance it is an infection, she says). The neurologist confirmed the diagnosis of Horner's but said she does not believe it is related to the mass, because of the mass' location in his brain.

TorontoVet said...

Cory,

Thank you for the update.
I am very sorry for you and for your dog. All the best.

Anonymous said...

Hi Toronto Vet,
I'd never heard of Horner's until my 14-yr-old lab Kwik (who's not) presented it this morning...droopy lid, sunken eye, third lid up, constricted pupil. Local vet called it Bell's Palsy, stained to look for foreign objects (found none), and prescribed an antibacterial eye ointment. There's no other sign of paralysis in the face, though he has at times shown sign of minor seizures and had a few twitches in his side and hind legs this morning. He has lots of other problems, and they could be related. He has a history of ear infections after swimming that I would treat on vet's instructions...they'd clear, come back, repeat, etc. He's now nearly deaf, but his ears do not appear to be infected or inflamed (I have a small Petscope), or to bother him.
Now the odd bit: He has hind quarters ataxia that may be related to an injury 6 years ago to his back that caused similar symptoms. His back end sways a lot, and his front legs also seem to pain him from time to time, though he's always been incredibly stoic when in pain. Things like Rimadyl have all caused gastric problems, so it's hard to find him relief. My chiropracter said she's had good luck treating dogs for such things, and I let her do some manipulation with an activator 6 days ago. Poor Kwik got worse the next day, but then improved a bit in his movements this past week. I saw you mention that Horner's can be caused by tumor to the thoracic vertebrae. Now I'm wondering if Horner's could be related to chiropractic manipulation? So my questions are 1)What to do about the Horner's? and 2)Is it safe to repeat the chiropracty to help ataxia (and pain) in my old dog?

TorontoVet said...

Dear Anon,

Sorry to hear about what's going on with Kwik.
No, I don't think the chiro's manipulations caused the Horner's syndrome. To bottom line it: I think the dog requires an MRI of the cervical and (upper) thoracic spine. Having said that, a GOOD (I mean really good!) physical exam need to be done first. It is very possible that the dog has a Hansen type II disc lesion (i.e., chronic and not acute) AND, say, a middle ear infection causing Horner's syndrome. Horner's is not Bell's palsy. Bell's palsy is facial paralysis, which commonly occurs IN CONJUNCTION with Horner's as the 7th cranial nerve courses in the middle ear, and can become affected with severe or chronic infections.
So, the first step is a GOOD physical exam. Then a referral to a neurologist for a MRI of the middle ears and the spine.
Hope this helps! Good luck.

Anonymous said...

I have a two year old Pug who was diagnosed yesterday with Horners. He has had frequent ear infections and has been on Mometamax on and off for months. I am concerned that he is so lethargic. He is eating, drinking...he does not stumble or appear confused however he is very lethargic..no energy. I find that at times he actually gets "depressed"...he had stenotic nares surgically repaired last year and had to wear a collar for two weeks. He was visibly distressed and seemed to have no "will" left in him. He gets very disturbed by things he seems not to understand. I am wondering if it is possible that he is just confused by this eye condition and is acting "depressed" again, or if lethargy is a symptom of Horners. This just came on instantly yesterday, and we took him to the vet right away. Anyone have any ideas?? We are beside ourselves worrying about him! Thanks for reading!

TorontoVet said...

Dear Anon,

Thanks for sharing your case with me. I am strongly suspecting chronic otitis media (middle ear infection).
This would be confirmed on x-rays, or ideallyl a CT or MRI (x-rays often don't show the problem, even when it's there).
Another procedure that could help with the diagnosis is a deep ear exam while the dog is under general anesthesia.
I would get going on this before he gets worse (regardless of the cause). Keep me posted and good luck.

Sassy said...

Hi, my female mixed breed is 7yrs old and a few weeks ago I noticed her eyes were tearing and on one side of her face her lip looked droopy. About 2 days ago she started showing the signs of Horner's...droopy lower lid, not blinking, instead of blinking her third lid is protruding at times. When she is sleeping her eyes do not close all the way and the third lid is visible. Other than these symptoms she seems fine. I took her to the vet yesterday and they were no help at all! The answer was lets see how she does over the weekend.
I have a feeling it has something to do with her inner ear. When the Vet looks in her ears they looked fine, but my understanding is that an inner ear infection can only be seen with an xray.
If she is having inner ear issues what is the treatment? What kind of antibiotic? Should she also be on steroids in addition to antibiotics?
Thank you very much for any advise you can provide,
Krystina & Mocha

Sassy said...

Hi, I just asked a question a few mins ago. I forgot to mention the eye symptoms are bilateral and she is starting to drool a bit.

Thanks again,
Krystina & Mocha

TorontoVet said...

Krys,

Thanks for providing me with details. An important question: are her pupils really small, or is one smaller than the other? The protruded eyelid doesn't mean it's Horner's. The inability to blink and the drooling are both signs of facial paralysis (deficits of the 7th cranial nerves), like Bell's palsy in humans. Horner's alone doesn't cause facial paralysis! This could be due to bilateral otitis media/interna (middle or inner ear infection, often accompanied by Horner's), hypothyroidism, a tumor, infection/inflammation, or is OFTEN idiopathic (meaning no discernable cause).
All causes of facial paralysis need to be explored here.
Good luck and KEEP ME POSTED!

-TorontoVet

Anonymous said...

hi,
I have a 7 yo lab x ridgeback that was diagnosed with Horner's this morning. He appears to have just woken up with it, so the vet has suggested that it is idiopathic. But the main concern is that his other eye occassionally shows the same symptom. It is not present all the time and can look quite fine, then he will look at me and the lower eyelid droops open and the third eyelid comes across a bit. It is not nearly as bad as the other eye. The vet couldnt explain this and is not completely convinced that it is Horners and has asked us to keep a careful watch for any changes. Do you have any suggestions as to why the other eye would behave in this way?
Thanks
Sheryl

Caroline said...

My 9 month old bloodhound woke up this morning with both eyes sunken in. Her right eye deffinatly has a swolen third eyelid and her left eye cant even open. You can see the she tries to blink, but that eyelid she cant open. Like I said before, both eyes are sunken in. For the past couple of days, both of my dogs (my other is a catahoula) have eaten and drank very little. I have to hand feed them. Also, I had to keep them in the kennle over the weekend. Once more thing is that I have changed their food. So many things have been going on this past week, I dont know which could have caused this. As far as the descriptions go, it looks like she has horner's but its in both eyes as the same time. She is at the vet's right now, but they arent having any luck. Any thoughts would be appriciated.

Anonymous said...

My basset mix was diagnosed today with Horners. But now he is coughing weirdly. I will call the vet Monday, but could he have nerve damage in his neck? He has gladular/lymph node disease already but not cancer. Had a lump taken out of his neck where a human's adam apple would be last year. He has fatty tissue lumps in several places. 12 yrs old.

Anonymous said...

I am trying to determine if my 11 month old lab has Horner's. He came home from playschool on Friday and both eyes are rolling back in his head, third eyelid rolling up. It lasts for about 10 minutes and during this time he lays down and closes his eyes. When it resolves his energy and behavior are completely normal again. The vet washed his eyes out and checked for scratches and debris and found nothing.

TorontoVet said...

Thanks for the post. Take him to the vet so that he/she can determine whether or not it's Horners. That's what vets are for.

Christine said...

I have a 14-year-old Border Collie who has been diagnosed with possible Horner's syndrome. Both eyes are drawn medially toward the nose with that membrane coming up partially giving him the appearance of being cross-eyed. The right eyeball is somewhat reddened. Do you think it odd that this would occur bilaterally?

herman said...

Three days ago my 12 year old Sheltie began showing Horner's syndrome symptoms. Coincident with the onset was a peculiar type of breathing, a loud, fairly rapid inhalation through the nose followed by a rapid and noisy exhalation through the mouth. Both symptoms continue today.

A visit to the vet confimed Horner's with treatment being eyedrops 3X daily. A thorough examination was done including ocular pressure, tear function, temperature, heart, lungs. All tests revealed no abnormalities.

The vet hopes it is idiopathic but I am curious about the onset of the peculiar breathing described and whether the two symptoms are related.

Thank you for any help,

Herman

TorontoVet said...

Herman,

Thanks for your comment. A dog with Horner's syndrome and concomitant breathing symptoms would prompt me to perform some chest x-rays. I would also have a good look deep into both ear canals and even conside x-rays of the little round spherical bones containing the middle ear called "bullae."
True Horner's is a problem with the sympathetic branch to the eyes. A problem may lie anywhere between the eyes and along the cervical spine, down to T1-T3, where the nerve courses.
If your vet truly suspects Horner's, I don't really understand the prescription of the eye drops - perhaps just to lubricate the eyes?
Again, this is not an eye problem per se.
All this said, a huge percentage of cases are idiopathic.
Hope this helps. Keep me posted on the dog's condition.

Anonymous said...

First things first...I want to thank you for this blog...and all the information it provides us.
We love our pets so much and really appreciate the advice or opinions you provide to us.
Now, my 12 yr old Jessie a Rhodesian Ridgeback was diagnosed with diabetes last week. Her symptoms were huge water comsumption (which she would end up vomiting), lethargic, difficulty standing. Her blood sugar level was 29 mg/dl. Twice daily caninsulin injections have helped bring it down to 9.5 as of today :). However, two days ago, when she was still very sick, she started showing signs of Horner's drooppy eye, third eyelid and no real discharge. The vet who did her follow up today, mentioned the Horner's and did the dye in the eye for foreign object and nothing was found. He gave me antibiotic gel and told me it could take up to 4 months to clear. I've done some reading but found no link between Horner's and diabetes. Any advice

Ken said...

I have an 8 year old Am. Staff Terrier. About a week ago he started showing signs of facial paralysis on the left side of his face. I have had him to both the ER and the Vet and they were unable to find a cause. Today I now see that his right side is also affected in the same manner when it was not 15 hours ago. Can anyone please give me someinsight... ill be watching for a reply PLEASE HELP

Anita Jensen said...

Hi all, this is to help allay some fears. My schipperke, who was around 11 at the time, was diagnosed with idiopathic Horner's syngrome, He wasn't sick , but I thought his right eye was bulging.. with the vet we looked again, and yes, the right eye was fine, the left eye had sunken. Warlock lived to 14.5 wonderful years.. some times when the horners came back, we just looked at the elvis presley sneer & put in some eyedrops if he seemed bothered.

Sometimes idiopathic is just idiopathic.

CanineDivine said...

My 11-12 year old australian shepherd has a droopy upper lid, but her eye is dialated. The opthamologist diagnosed Horners. My local vet considered that but dismissed it due to the dialated pupil. The specialist said her eyes aren't dialiting correctly anymore because of her age, and that is not uncommon in light eyed dogs (hers are very pale blue). My dog has not appeared to be in any pain nor has her behavior altered in any way. Other than having less "sits" in her, she's really in pretty good shape for her age. Full panel in spring was great. She's on an excellent diet, holistic suppliments, and regular chiropractic and massage. I cannot afford much for diagnostic tests, and since she's mildly epileptic I am not keen to do anything requiring sedation anyway. Are there cases of Horners with dialated eyes? Should I be worried that this could be a tumor or something?

TorontoVet said...

Divine,

A truly dilated pupil, or one that cannot constrict, is a result from a lesion of the 3rd cranial nerve, called the oculomotor nerve. Interestingly, this nerve is responsible for OPENING the eye (closing requires the 7th cranial nerve).
Did the ophthalmologist say that the dog had atrophy of the iris (the coloured part of the eye?). Iris atrophy results in a larger pupil but that's not true dilation of the pupil. If it is indeed iris atrophy, Horner's is possible, but with it you typically also have a protrusion of the 3rd eyelid, found in dogs and cats, and a sinking back of the eyeball, which is often difficult to appreciate.
If there is NO iris atrophy, this isn't Horner's. Period. By default, Horner's can only result in a constriction of the pupil.
To see just a lesion of one of the oculomotor nerves is rare, in my experience. I think this dog requires a COMPLETE neurological assessment. The dog could have a lesion somewhere else, including the brainstem.
Follow up with this and please provide feedback. Best of luck.

Anneeby said...

My 9 yr old lab had two seizures last month with 3 months of ataxia and behavioral changes. The worst symptoms occurred right after she ate. Sometimes she acts like she has Alzheimer's. The vet put her on phenobarbital. I took her to a neurologist who said most likely it is a brain tumor. She seems to have Horners in one eye. In the exam the pupil of the affected eye did not dilate in a dark room. I have already spent a fortune on vet bills and an MRI is out of the question. I am making all of her food and she seems to be getting a little better. The ataxia has lessened considerably and she is more "with it". Do you have any suggestions?

Anonymous said...

In response to the very first post, your cat 'orb' probably does have horners...more specifically congenital horners, since iris pigmentation is under adrenergic control during development, thus explaining the heterochromia.

Anonymous said...

Can Horner's affect both eyes?

TorontoVet said...

Yes. It all depends on what is causing the Horner's. Bilateral middle infections can cause bilateral Horner's. It's harder to spot because both eyes will look the same.

Anonymous said...

I have a 7 1/2 year old Siberian Husky/Yellow lab mix. Dec 2009, Teddy became hypercalcemia. We did multiple tests for thyroid and cushings disease. Nothing was found. After a week of predizone it went away for a month and then came back. Since then we have done biopsies of the liver, kidney, and ultra sounds of the stomach. Chest, neck, back and leg x-rays have been done also. Still can not find the tumor. The tumor may be in the neck as we now have him in a neck brace since he was having a lot of pain moving the neck. I take him to acupuncture and chiropractic treatment every Tuesday. This has helped a lot with the neck pain. The therapist vet says she see's arthritis in the neck. This weekend Horner's syndrome came on quickly. The emergency vet said it was most likely related to the tumor we are looking for and cant find. If Horner's is brought on by a tumor will it go away or stay permanently. I just want Teddy to have a reasonable quality of life for what he has left. He is on tramadol, predizone and amandatine right now. We still go for a 2 daily walks but for the most part he just sleeps inside or outside. I cant stand seeing him in pain but I am out of options. Looked at an MRI but I cant afford another 2,000 dollars past the couple thousands I have spent in the last 3 months with testing. He also had acl surgery 2 years ago and again last year to remove the plate since he wasn't healing. That finally healed up fully around Aug 2009.

TorontoVet said...

I'm sorry this is happening to your dog. First of all, hypercalcemia does not automatically mean a tumor is present. It certainly is possible, but other issues can cause hypercalcemia.
A calcium profile can be done, looking at ionized calcium and a PTHrp (parathyroid hormone related-peptide) to see if the hypercalcemia is significant and the latter will essentially tell us if a tumor is present.
Were x-rays done of the tympanic bullae (the little bones at the base of the skull which contain the middle ear)? Bone lysis from a middle ear infection may cause both hypercalcemia and Horner's syndrome - something to consider. X-rays of this region are not very sensitive but I would expect some sort of radiographic evidence based on the chronicity of the problem.
Best of luck and please keep us posted.

Anonymous said...

I have a 20 month old lab who tore his acl 1 week ago. He now seems to have all the symptoms of Horner's that I read in your blog. The vet this morning thought it could be an alergic reaction and put him on benadryl. Should I talk to him about Horner's and see if he actually may of had some damage done elsewhere when he initially hurt his leg.

Anonymous said...

Another post from the 20 month old lab. My dog was diagnosed with Tetanus. The eye symptoms are similar but progressed into a frozen smile with eyes pulled back. Luckily we think we've caught it early and he hasn't got worse today. It will be a couple weeks before we can say its over. Just goes to show you, if your gut tells you something is seriously wrong keep asking questions.

Anonymous said...

Took Teddy to the vet on wednesday for his routine annual check up and vaccines. Showed the vet your response and he looked at both ears but said he didn't see anything wrong to warrant taking x-rays.

Anonymous said...

My 12 yr old yellow lab, golden retriever mix was diagnosed with Horner Syndrome 2 days ago, we did x-rays and our Vet seems to think it is idiopathic. Yesterday her eye looked good today her eye lid is drooping, its off and on. I am wondering if more or less activity helps, or if massaging around the eye might stimulate the nerves, I would like to be proactive and do what ever i can to help her eye get back to normal.
thanks Moe in Oregon

TorontoVet said...

Moe,

X-Rays are not that sensitive in picking up problems in the middle ear. Kudos, however, to your vet for having done them anyway! Chances are (and big chances) that it is indeed idiopathic.
Idiopathic or not, the nerves responsible are too deep and course nowhere near the surface of the body. Your desire to help is noble, but be patient.
Take care and thanks for the comment.

TorontoVet said...

Moe,

By the way, chest x-rays should be done, too.

Anonymous said...

Our vet did do several x-rays, chest, spine, head. He explained x-rays can't see the soft tissue, but everything he saw in the x-rays looked good. One more question... does it affect her vision? Sometimes the 3rd eye lid is only partly showing other times it shows a lot. I'll be patient and I am sure she will get back to normal soon.
Thanks for the info Toronto Vet
Moe in oregon

AimeeJames said...

I have a question. We have two inside cats and have recently 'adopted' an outside cat. She sleeps on our deck and comes and goes as she pleases. We have started feeding her and giving her water but I've noticed that she looks just like the cat in the picture with this Horner's syndrome. She won't let us touch her, yet, but I am working on it. I wanted to see if you think she's in any pain? Other than the white on her eye she seems pretty healthy, small, but healthy. I just wanted to know what else you could tell me about the eye and like I said to see if she's in any pain. Thanks!!

TorontoVet said...

If her third eyelid is covering her eye because of Horner's syndrome, she's likely not in any pain.
If, however, the third eyelid is covering her eye because of an ulcer or any other eye problem, she might be painful.
It would be great to catch her and bring her to the vet if at all possible.
Just make sure she doesn't come into contact with your cats as she might have something contagious.
Thanks for the comment and keep me posted!

AimeeJames said...

I will keep working on gaining her trust so that I can get my hands on her and get her to a vet. I don't want to freak her out since she doesn't seem to be hurting. She is very talkative, eats and drinks well, and the only thing I see is that white eyelid. Some days it looks like it is covering her eye more than other days. But I will keep you updated. Thanks for the help!

Anonymous said...

Hi Doctor,

My 13 year old dog Penny was diagnosed with Horner's Syndrome. I took her to an eye specialist who said that there was a good chance it would go away by itself within a few months. I started noticing Penny's third eye back in December. It is now May and there is no sign of the condition improving. I've read that Horner's Syndrome can be caused by an underactive thyroid and also by something viral. Penny has had an underactive thyroid since she was 6 and has been on thyroid medication since then. Last year, she was diagnosed with IMHA from which she seems to have had a complete recovery. She went off the medication for it back in October 2009. My concern is that she seems to have lost her depth perception and is walking into things. Also, starting about a week ago she has been losing her balance. Should I continue to wait to see if the Horner's clears by itself or should I have x-rays or an MRI done to try to find the source of the problem?
Thank you so much for your advice.

Kelly said...

My 13 yr old Yellow Lab was just diagnosed with Horner's. He also has a very large lump on the back of his leg that has grown substantially. We realized that he has lived a great life, but the problem is his teeth are very infected and he needs to go under anasteshia (sic) to fix his teeth and the vet will not do it unless she can find the cause of his Horners. Do infected teeth hurt him? Please suggest any options that we may have.

TorontoVet said...

Most cases of Horner's syndrome are idiopathic (no underlying cause can be found). Severe periondontal disease, in my opinion, is a very good reason to put ANY dog under general anesthesia. The pros of a dentistry (cleaning, extractions, etc) definitely mitigate the risks of anesthesia. There is no reason the dog cannot be worked up for Horner's: chest rads to look for tumors, careful otoscopy and xrays of the tympanic bullae to look for middle ear infection (though xrays are not very sensitive).
By proximity to the middle ear, by the way, the infected teeth may have lead to a middle ear infection, and consequent Horner's.
The bottom line: if the ears look good and the chest rads are clear, the dog should definitely have a dentistry.

Anonymous said...

We have a 9 yr old Cattle Dog who was hit by car June 28th. She suffered broken bones in her face around the left eye and the eye was very bloody, swollen, and initially bulging out of the socket. On her first visit, the Vet said she would most likely lose the eye, stitched her cheek closed where the bones had broken the skin, and had us start rinsing the eye with saline and apply neosporin. A week later, her eye looked MUCH better and almost appeared normal but with some bloody/mucous drainage. Vet gave the eye a 75% chance, said everything appeared to be attached with blood flowing, etc. He said there was some corneal damage but that it would most likely heal itself. We continued with the saline and neosporin ointment. As of about two weeks ago, we noticed the 3rd eyelid moving up, droopy upper lid, eye looks to be sunken back into the head. Now the 3rd eyelid completely covers the eye and it is bright pink. The broken bones in her face are almost completely healed and if it weren't for the eye she appears completely normal. Other than the left side of her face, she suffered no other broken bones and wants to run, jump, chase balls, and seems to have 100% of her capacities. I'm wondering if it still possible that she could have an ear infection, ruptured eardrum, or even blood clot pressing on the nerves, causing the Horner's syndrome or something worse that perhaps isn't healing properly? We have an appt with an Opthalmalogist Vet in 2 weeks but wondering if she should be seeing a neurologist instead?

judith said...

Gracie-7 yr old standard poodle- does have hypothyroid, but vet doesn't Medicare because G is so slim she can't afford to loose weight.
Within the last year she has had a serious liver infection, which we treated as Lepto, and she also got nipped in a rear leg by a coyote, tho the skin was not broken & she scampered away apparently unharmed after 2-3 limping steps.
About a month ago I noticed that her face is no longer symmetrical: one side has contracted, so that the skin that usually hangs over the lower mouth no longer does and her nose is pulled over to one side. There is, I think, some fairly constant clear nasal discharge, because she licks that side of her face. She also frequently gently 'smacks' her mouth- pushing tongue against mouth roof and then slightly opening & closing mouth.
I've been reading about Horners since a call to my vet- before that the only thing a found on line was palsy and facial paralysis.
Grace has none of the dramatic markers of any of these. No third eye, no protrusion. Her spirits and strength are excellent, appetite & elimination great.
She is raw fed, with supplemental support for thyroid and liver as well as general vitamin.
So- her symptoms don't match, but could she just be at an early stage? So far, her face is static- no better, no worse. She can close both eyes.
I am confused at not finding any anecdotal match, but this is the best discussion I've found. Thanks for listening.

Janet said...

Tiger, my 5 year old cat, developed Horner's syndrome after a lateral ear resection for chronic ear infections. In the 4 weeks since surgery her affected eye has closed down to a slit, and she has developed progressive facial nerve paralysis. She does not appear to have eye pain. The pupil is small, the third eyelid covers most of the pupil, the conjunctivae seem normal and her lip droops. In the past two days I have noticed staggering.

How can we distinguish between vestibular signs (possibly due to ongoing inner ear infection) vs. a drug reaction?

She has been on metronidazole for the past 3 weeks (10 mg/kg twice a day), azithromycin (5 mg/kg for 10 days) as well as prednisone, ondansetron, famotidine and clindamycin/dexamethasone ear drops. We are also using lubricating eye drops.

Cultures were not taken at the time of the ear surgery. She was presumptively put on enrofloxacin 5 mg/kg and tobramycin ear drops. Cultures done the week after surgery (while on antibiotics) grew strep canis and fusobacterium.

Initially my vet told me that we would have to continue the antibiotics for 8-12 weeks. Now he has suggested stopping all of the topical antibiotics and the metronidazole - just in case the antibiotics are either irritating the 7th nerve or that possibly the cat is having an adverse reaction to the metronidazole.

I am concerned because if the new symptoms are indicative of ongoing infection in the middle/inner ear, then Tiger may not be on adequate antibiotic coverage. We continue the Zithromax twice a week for the next 6 weeks, but there is no gram negative or anaerobic coverage. We are culturing the ear every week, but what is growing in the inner ear may not be present in the outer ear, and I am concerned that we may be missing something.

Anonymous said...

I have a Sheperd 10yrs has horners syndrome His right paw is very lame he has some arthritis in spine xrays show nothing wrong did lime disease test sent xrays to consult no idea help

TorontoVet said...

Hi there. Which eye is affected with Horner's? If it's the same side as the dog's paw, this would strongly suggest a problem around the T1-T2 (or thereabouts) spinal segments.
The nerves (from C6-T2) that come off these segments innervate the muscles of the front legs. The sympathetic nerve courses around T1-T3 and it is a problem with this nerve that causes Horner's syndrome. My apologies if this is a bit confusing. The dog should first have chest x-rays done. If normal, I would get a referral to a neurologist for MRI of the cervical intumescence (C6-T2).
There is certainly a possibility that the two are NOT related. The Horner's may be idiopathic (and therefore not a big deal) and the dog may have concurrent osteoarthritis. I'm leaning more towards one problem causing both.
Please keep me posted!

ankhorite said...

Toronto Vet, thank you for all the info you've posted here on the relationship between ear infection and possible Horner's.

For our six-year-old German Shorthair,in addition to rapid-onset bilateral diabetic cataracts (in only seven days!), our canine opth. DVM noted a constriction in the left pupil.

Our girl has had an intractable ear infection for over a year that we know of. She was rescued 12 months ago, and has been in treatment ever since with this and that.

While she's knocked out for the cataracts, because of you, we will ask Dr. Kelley Corcoran (now of Virginia, formerly of Canada, maybe you know her?) to do the middle-ear flush & culture. If you didn't have this page, I would not have known to ask for that.

THANK YOU for being so detailed.

Camille said...

Hello,
I understand that you are looking into Hormer's syndrome in dogs. I currently have a litter of Cocker Spaniel puppies and one of the litter has been a little 'odd' since birth. They have just had their 6 week vaccinations today and I asked the vet about the 'odd' puppy. She said it had Horner's Syndrome, and admitted that she has never seen it in a dog that young. Is it possible that he has had it from birth. He was the runt and not very strong, and had to be bottle fed up until 4 1/2 weeks old. Your thoughts would be appreciated.

TorontoVet said...

Camille,

I have not seen Horner's syndrome in such a young dog. I have, however, studied a well-known database for veterinarians and a board-certified neurologist suggested that if the puppy is healthy and has no other neurological deficits, even an extensive investigation into this would yield nothing significant. That said, the puppy should be examined by a veterinarian, he should have a cranial nerve exam, and his ears should be checked thoroughly to ensure no evidence of a middle ear infection.
If other puppies are also showing any neurological signs, an infectious cause (such as Neosporosis) may be the culprit. I'm not convinced this is the case...
Keep me posted and best of luck to you.

Fat_Sezr said...

Hi TorontoVet - Your advice to all the dog owners dealing with Horner's disease is interesting. I actually have a question about my cat that I suspect to have Horner's syndrome. He went for a routine ear cleaning only to come home staggering, exhibiting nystagmus and the third eyelid on him left eye was protruding. He moves about normal now but his third eyelid is still protruding, his left ear seems to irritate him a little and his left pupil is smaller. The vet gave us Sufrolan for the ear, but if it's more likely a middle ear infection I think he will need different medication.. Any advice? (or what should I ask our vet?)

Worried in NM said...

We have a 6 year old Rottie girl that was diagnosed with Horner's about two months ago. We were told it would probably go away in 6 to 8 weeks. The 8 week mark is approaching and we are starting to worry. To make matters worse, tonight her OTHER eye looks just like the first one! :( Is this something to really panic about?

TorontoVet said...

I would see your vet and consider referral for this one. Has her thyroid been checked? Hypothyroidism can affect any nerve and since it's bilateral, I'd definitely rule out this disease with a thyroid panel. Has the dog been yanking on her chain? Trauma can cause this. Other more serious problems must be considered such as a central nervous system lesion (brainstem, upper spine, and thorax), so x-rays of the dog's thorax (chest) should now be done. One thing that must be determined definitively is that this is actually Horner's syndrome and not bilateral uveitis or dry eye (KCS) causing prolapsed 3rd eyelids. I encourage you to post a follow-up here as I'd like to know the outcome. Best of luck.

Anonymous said...

Dear Torontovet,
My 12 yr old lab/shep mix has had hip problems all her life. A few days ago she started limping, trying to keep weight off her left front leg. She takes a long time to get up (always has), moves very slowly and stiffly, and basically lays in one or two spots all day. Also, her left eye is drooping, etc. The vet yesterday says it's Horners and wants to do the eye stain, chest and spine xrays. What will the chest and spine xrays do besides show if there is any damage there? If there is, nothing can be done anyway. I can't afford it all, but I feel like I'm an irresponsible pet owner. I love my dog and I don't want her to be in pain. Right now she is on pain med. What should I do next?

Erin Broude said...

My 4 yr old Golden was diagnosed with Horner's back in Oct. She had the typical symptoms with her right eye. All tests were done and we could not find a reason why. It cleared up and by Christmas time and has been fine since. As of friday her other eye looks to have horner's. She was at the vets a month ago seen as a very healthy dog. No swollen lymph nodes etc. Why would it have switched sides? Will it go away as it did last time. It doesn't look as bad as the other eye first did. The right eye is still perfect!!! Thanks

TorontoVet said...

Dear Anonymous with the 12 yr-old lab/shepherd mix,
Horner's syndrome and a front-leg limp on the same side strongly points to a problem (or lesion) at the level of T1-T3 (1st-3rd thoracic spine) as the sympathetic branch to the eyes and the spinal nerves innervating the front legs course in this region.
You are certainly not an irresponsible pet owner, whether you can afford the diagnostics or not. Your vet has given you sound and reasonable recommendations. Chest x-rays should not be that expensive. I would consider omitting the spinal x-rays and save your money for an MRI, which would likely give you the diagnosis you are looking for. You can always try playing the waiting game and see if the dog gets better, so long as the dog isn't suffering in any capacity.
Erin, there is a huge chance that it will go away without treatment, just like the other side. Have a vet take a look-see in any case.

TorontoVet said...

Dear Fat Sezr,
I apologize about missing your comment.
Your case is widely described in the literature: many cats after ear cleaning develop Horner's. It can occur with cleaning of the external ear canal, and should resolve in 3-6 weeks. That said, some don't resolve. If the cat's ears were dirty/infected, the ear drum may already have been compromised or torn, making the cat a ticking time bomb for Horner's anyway. So a middle ear infection must be ruled out.
Hope this helps.

Jon said...

Hi,
We have a 6 year old golden retriever. He was diagnosed with Horners last year which resolved on its own eventually. We discussed with the ophthalmologist whether it could have been caused by him pulling on his lead, which affected the nerve in his neck. A possiblity, but he obviously couldn't commit himself without further tests. We started using a head restraint to leave the neck free, and gradually soon after the Horners resolved, which could just have been a coincidence of course.
However, just recently his other eye shows signs of Horners... it is sunken and the third lid is prominent. He has had issues with ear wax in the past, but never diagnosed with an infection as such. His behaviour seems normal. We were offered an MRI scan for him at the original visit but declined. Now we are having second thoughts. Do you think we could hold back and see if it resolves as before?
Many thanks,

TorontoVet said...

Jon,
I wouldn't be too concerned, but I haven't examined your dog so trust your vet's recommendations.
The statistics suggest that most cases of Horner's in dogs resolve on their own. In your dog's case, that one eye already resolved on its own suggests that the same will occur with the other eye.
A long while back I had told one reader that pulling on a leash cannot cause Horner's syndrome. This is not the case. There is some evidence that it can as this is exactly where the sympathetic nerve runs (albeit, very deep). Keep me posted!

Harriet said...

my dog has been diagnois with horners. The reason has not been determined but about 11 months ago he started shaking his ear constantly the vet found wax which has been cleaned out repeatedly but didn't help with the shaking. the dr. recommended a deep otoscopy but it was $400 of which I don't have.I used some ear solution with boric in it and now he's not shaking his ear anymore but he has horners and throws up all the time even water and has the dilated left eye with the droping bottom lid. I was told to give him a blan diet of rice & chicken or hamburger and give him small quanities at a time he's not getting enough calories. He has started loosing alot of weight and today he doesn't want to eat and is acting very sluggish. I'm very concerned.What can I do to help him keep his strength up?

TorontoVet said...

First of all, how old is your dog? Horner's should cause miosis (constriction) of the affected pupil, not mydriasis (dilation). A common cause for Horner's is a middle ear infection, which may also cause facial paralysis. Horner's can be caused by a number of things, from idiopathic disease (i.e., no underlying cause), to middle ear infections and thoracic tumors. Your vet has made good recommendations in order to try to learn what may be the cause. If finances preclude further diagnostics, I think a course of antibiotics, especially clindamycin or enrofloxacine, would be reasonable. Good luck.

Anonymous said...

This is "Worried in NM" again who posted on April 5 the last time. We took my Rottie girl back to the vet at the 12 week mark. By then the second eye cleared up, but the original eye is still the same. Now she can't feel her whole muzzle (she puts the whole thing a bowl of water) and the vet suspects it is affecting her thorax. When she is eating or drinking water, there is an ungodly amount of drool and mucus. The vet says she doesn't seem to be in pain because her heart rate and BP is still normal. She will still play with me some, but seems to be getting tired much faster. She does have a hard time eating, I'm sure, because she can't feel her muzzle. You can also hand her a treat and see she can't feel it normally. Takes her a few seconds to just grab it. The vet says she may be this way permanently. I don't know what to do. Should we still go ahead and do a thyroid panel? The symptoms are DISGUSTING but we don't want to leave her outside. She's our baby! :(

TorontoVet said...

Yes, have a thyroid panel done.

Michele said...

Hi,

We have a 6 1/2 year old yellow lab that we took in to our vet because of a sagging eye and lip on his left side. Our vet diagnosed him with Horner's and said it may be thyroid related. She ran a full blood panel and discovered that his lymphocite count was very high, the lab examined the pathology and he was diagnosed with lymphoblastic leukemia. That was 2 1/2 weeks ago. I am wondering if you know of any link between lymphoblastic leukemia and Horner's? Our vets have said that the Horner's doesn't "fit" with the lymphoblastic leukemia necessarily. He has not shown any signs of the leukemia (yet) slowing him down - still eating, drinking, playing, chasing the cats. I was almost wondering if there could have been some sort of mix-up at the lab with is blood because he is still acting so normal and from what I have read this type of leukemia is fast moving and not treatable to any positive outcome.

Because of the grim outcome no matter what treatment, we opted to only give him prednisone. He was on prednisone for a couple of days, but he developed such terrbile diarrhea that we stopped with that over a week ago. As of yesterday his eye seems to look worse from the Horner's - it was not sunken in before and now it is and I wondered if this is any sign of the leukemia getting worse? The only physical symptoms that seem to bother him are from the Horner's. He rubs his eye periodically and he sounds slightly congested in his nose. I appreciate any thoughts you might have about this.

Thanks!

Anonymous said...

Hi
My dog is a 13 year old retriever cross. He was diagnosed with diabetes about 2 years ago and has been regulated closely ever since. This morning he woke up with the third eye lid covering a good proportion of the eye. He has been to the vet and is on antibiotics. What types of things can this be related to in serious cases of hornets. The vet said that worst case scenario it could be from cancer. Can you please explain. Thankyou

TorontoVet said...

Horner's syndrome occurs when the sympathetic branch to the eye is disrupted. This can occur from many things including a middle ear infection, a tumor, spinal disease (tumor or disc), or a tumor or mass in the thorax/chest. Even yanking hard on a dog's leash can cause it. Horner's syndrome in the majority of retrievers is idiopathic, which means no discernible cause can be found. But a work-up is still needed to rule out all other causes. Hope this helps.

wh00pwh00p said...

Hi,

Sorry if something similar to this has been covered there were just so many posts to read!

I took my dog Chip, an 8 year old chocolate Labrador to the vet with a "problem with his eye". He has been diagnosed with Horner's syndrome due to the droopy eye, prominent third eyelid and constricted pupil.

My question is at what stage should we be looking for a (possible) cause? The vet said it should take 4 to 6 weeks to resolve and that was it.

thanks!

UkEllie said...

I have come across your interesting blog.... I can only say thankyou for bothering to write it... My cat I have been told this week has the symptoms of Horners Syndrome.... I am very worried for her as she looks awful... Her face is wet through from the dribbling... Eye pupils both different sizes... Lost lots of weight... Looks very fragile and wobbly.... And only a week ago she was a completely well and happy cat... I am at a loss of what to do for her... The vet has given her a second steroid injection and a course of steroid tablets for the week.... Is there anything else we can do to help her? I'm feeling completely useless and I want to help her recover... What's your thoughts? I can send photos to help... Thanks...

TorontoVet said...

Dear whoopwhoop, your vet is probably right, but not all cases of Horner's are idiopathic. This is a diagnosis of exclusion. I'm afraid there is no correct answer to your question as a few approaches are reasonable. If the dog gets worse in any capacity, a full work-up should be done to rule out the potential causes of Horner's syndrome.
EllieUK, your kitty sounds quite sick. I would take your cat to another veterinarian for a second opinion (ideally, to a veterinary neurologist). She could have a serious middle ear infection, something more serious. How old is your cat? No more steroids for this cat unless the specialist says so! Best of luck.

Craig said...

Hi

I have a 4 month old Border Collie puppy. Yesterday afternoon, my son noticed a like a twtch in her right eye. When I got home from work it was fine. Before going to bed, she got like it again for a brief period. She was fine again this morning but again it went away before I left for work. Out of concern I went home lunch time to check on her and she was fine. I played with her, put her outside when she came in I gave her treats had her do her tricks etc. She was fine and then her eye suddenly got like it again and it looks so pittyful. I came back to the office and researched about eye issues in dogs and came across images of Horners syndrome and this is exactly what it looks like. She seems fine and it does not appear to bother her. I have not called my vet yet but will if this persists another day or so. In the meantime, is this normal for such a young dog? and can we continue to exercise her and carry on as we normally do with her? Thank you so much.

Anonymous said...

My 11 year old lab was diagnosed as diabetic right before Christmas. He is now somewhat regulated with a strict diet and insulin shots. Two weeks later I noticed all the signs of what I now know is Horner's, although when I took him to the vet he only looked in his eye and gave us Ophthalmic ointment, which hasn't done much. About a week ago we noticed a small open sore with a bit of oozing located on his back (near his spine and just behind his shoulder blades). He also had a large mass removed two years ago from under his "arm pit" which caused him to be very stiff when walking. Are all or any of these related? What would you recommend us to do?

TorontoVet said...

Dear Anon,

Most cases of Horner's syndrome are idiopathic (no discernible cause can be found). However, Horner's syndrome can be caused by a lesion along the upper spine (down to T1-T3). The oozing along the back near the shoulder blades is highly suspicious. That said, the oozing would have to be coming from way down below the skin (in the spine) to be related to Horner's. I doubt this. What was removed from his armpit? A mass could be anything from fat to a malignant tumor. Uncontrolled diabetes can cause neuropathies (nerve problems) so be sure his diabetes is well-controlled by having fructosamine levels done. A middle ear infection and a tumor or disease in the chest can also cause Horner's. He needs a good vet exam. Best of luck.

Anonymous said...

Hi ! My 15 Yr old pit lab mix dog was diagnosed with Horners' in his left eye over the weekend-classic symptoms now that I have done the research.He had a full range of blood tests and X rays to rule out anything else as well as identify the cause-nothing came up other than elevated liver levels which he has had for a little while due to Derramax. But now 2 days later he is starting to show symptoms in his other eye.Does it ever happen to both eyes or is it always only one eye? Thanks for any help !

Anonymous said...

Hello,
I just came across your website and need some advice. I have an 8 year old collie with Horner's. He is also exhibiting loss of appetite, vomiting and no energy. This has been going on for about a week and a half. The vet ran a Superchem/CBC/T4...all were within range except slightly elevated liver enzyme. We have started him on Cephalexin in case it is the ears. Is the T4 enough to see hypothyroidism or is a TSH required. My first collie had hyperthyroidism and exhibited constant vomiting from it...we treated with synthroid but the vet, where I used to live, always tested the TSH. Any advice you can provide would be much appreciated.

Thanks,

Maryann

TorontoVet said...
This comment has been removed by the author.
TorontoVet said...

To an anonymous writer: don't know what happened but I deleted your comment only by mistake: The vaccines are likely a coincidence. The fact that she has Horner's and a droopy face means that she also has facial paralysis. Horner's syndrome and facial paralysis are each caused by different nerves. They most commonly occur together with a middle ear infection. I am very suspicious of this. This can occur even if the outer ear looks good. In my opinion, the dog should be on either a fluorquinolone or clindamycin, two appropriate antibiotics for middle ear infections. Good luck!

TorontoVet said...

Maryann, a complete thyroid profile should be done because any illness can falsely lower the dog's total T4. The gold standard is a free T4 by equilibrium dialysis (EQD). A thyroid profile often includes a T3, T4, fT4 by EQD, a TSH, and looks for the presence of thyroglobulin auto antibodies. While TSH is very accurate in humans, it is only useful when very high, not when normal, so a lot of false negatives. Take care!

Anonymous said...

My 10 year old Golden Retriever was diagnosed with Horners yesterday. She also tested positive for Lyme disease. The vet did not think the two conditions were related but I have to wonder.

TorontoVet said...

I assume the dog tested positive on a snap test? Many dogs do, it just means they were exposed to Lyme. The vast majority do not exhibit symptoms. The Horner's is far likely not related so I must agree with your vet.

Anonymous said...

My 13 year old Golden Retriever, Reilly, appears to have developed Horners two days ago. He has all the classic symptons. My question is this: I have a vet appointment tomorrow (Friday) but my husband is out of town until Saturday. I think our dog and I would prefer if he could attend the appointment with us. Can the visit wait til Monday or is it urgent? Reilly is acting otherwise normal...begging for treats, etc. I am just worried that if I don't go tomorrow he may be missing out on valuable drops/treatment.

Also, will he have to stay at the Vets office for tests or do they usually take place while we wait? I am just hoping this is idiopathic as he is getting older and we have been lucky so far.
Thanks so much!
Sherry

Anonymous said...

I have a Golden/Samoyed mix with Horner's Syndrome and a deep red/purple tongue - is the tongue discoloration a symptom of Horner's Syndrome? Thanks!

TorontoVet said...

No, it isn't! Horner's syndrome affects the eye, not the tongue.

TorontoVet said...

Sherry, but you need to see the vet (I'm sure you already have already). Many cases of Horner's in Goldens are idiopathic. But not all. Good luck!

Anonymous said...

Hello,

My cat seems to be having trouble opening her eye. The milky white inner eyelid does not want to retract, and she is acting a bit lethargic (still eats, jumps and moves... but is slower and wants to play less) The eye itself looks like that of the cat with Horner's you are pictured. I did manage to open the eye and do not see puss, excess moisture, bleeding or anything like that...just that eyelid. It has been less than 24 hours since the symptoms started. I am going to monitor it for a day or so more. Any further suggestions?

Thanks,

Deb

mardie said...

I have an 8 yr old white female Boxer who has been diagnosed with Horner's Syndrome. She is not deaf. Since then she has been falling a lot on the side that has been affected. Has been more lethargic does not bug me to go outside evey 5 minutes as normal. She also has facial paralysis droopy jowel on that side as well. She also holds her head to that side more too. I am wondering if the falling is because the sight is affected because of the syndrome or some underlying cause. She has a tumor on her pinky toe on her front opposite side of the syndrome, that the vet said needs to be amputated. A friend of mine says she looks like she walks drunk. When toe is amputated is being sent to verify it is not cancerous. Her surgery is scheduled for Wednesday the 30th. Should I wait for the results or have her have an x-ray or MRI scan now? Any thoughts?

mardie said...

I have an 8 yr old white female Boxer who has been diagnosed by the vet with Horner's Syndrome on her right side. Since then she has been falling a lot on the affected side. She also has facial paralysis on that side, her jowel droops. She has a tumor on her left front pinky toe. That toe is to be amputated Wednesday June 30th and to be send out for diagnosis of cancer. She has been lethargic and does not bug me to let her out every 5 minutes as usual. I am wondering if the falling is from the Horner's Syndrome affecting her sight or if the Horner's Syndrome is the result of underlying problem? She walks with her head to the right as well. A friend of mine says she looks drunk when she walks some times. Do I wait for the toe biopsy to come back or have an X-ray and MRI now? She has had no injuries or ear infections. Thank you.

Anonymous said...

Hi, We have an 8 1/2 Black lab who has been diagnosed with Horner's a few weeks ago. He also had a few reverse coughing fits before this started. Our vet checked him over and said his heart is fine ( I was worried about Heart failure). He has slowed down in the last three months and seems to run out of steam now more quickly. Is this due to his age (and he has a arthritic rear knee joint which he is on Metacam 10 to 15 units a day)
He weighs 39kg and has an very good appetite. Could he be suffering from thyroid problems or just getting old?
Thanks

james said...

I picked up a american cocker from a rescue a while back painfully thin with Horner's syndrome. When I say thin I mean thin. When trying to feed it Kibble it kept falling out of its mouth , so I fed it a soft home cooked food which it tore into like it had never eaten before. That was 10 weeks ago it now maybe a little bit over weight and the eye seems to be slowly returning to normal. Is this common accurance the dog is 1 year old anyhow I recommend soft food for a dog with these symptoms.
Thanks for great article

Anonymous said...

I have an 11-yr. old Rottie mix who was just diagnosed with Horner's Syndrome. I was given antibiotic eye drops for her eye and atropine (to be used for a week). She suddenly had an "episode" of severe head tilt and staggering off-balance. It came on suddenly. About 3 hrs. later she was much better and the next morning she was normal. A week later it happened again and now 2 wks. later it happened AGAIN. After the 1st one, I took her back to the vet. They ran a complete blood screen which was perfectly normal and did some neurologic testing. They felt the Horner's was idiopathic, but now she just had ANOTHER head tilt episode and this one seemed worse. Two yrs. ago she had malignant melanoma in her toe and it was removed. I thought I'd lose her within 6 months after that, but it's been 2 yrs. Could these "episodes" be caused by the cancer returning? No x-rays have been done yet, but I plan to call the vet again on Monday morning.

Anonymous said...

Our 14 year old dalmatian has just been diagnosed as having Horner's Syndrome with vestibular disease. What resources and suggestions are there for helping & living with a dog while waiting for them to heal?

Our dog has strong heart & lungs and likes to walk alot. He started to do repetative clockwise loops and problem is that he runs in to things and has taken a few tumbles. We have ended up walking with him keeping our hands on his sides but it is tough to keep up with him (and hurts my back walking crunched over). I worry about his hurting himself. Suggestions?

Thanks!

***
As a side note (different topic): We have had great results working with a Bowen Technique practitioner to help some of his spine/nerve issues. He seems to love the visits : doggie massage with benefits!

Robert Tatman said...

We have a 9yo Spaniel mix with Horner's. She has a baseball sized fatty growth behind her front left leg extending down around the exterior chest wall. Could this be the cause of the Horner's?

Anonymous said...

Dear Torontovet,
I stumbled apon your blog, and I must say, it's awesome!
I just returned from taking my 6year old lab/rottie mix to the vet for an eye problem that our vet diagnosed as Horner's. He has all of the classic signs, although I've never heard of it until today. I started thinking about the fact that over the last 3 months, he has been diagnosed with COPD, and is on 60mg Lasix twice a day, Theophylline 200mg twice a day, and has been on 20mg of Prednisone twice a day, as well as Zyrtec once a day. I know that both T3 & T4 can be lowered by the use of long term steroids and Lasix. Do you think there could be a correlation to Horner's and him having a medication induced Hypothyroidism? He has not had any blood work done lately.
Thanks,
Sue

Anonymous said...

Dear TORONTOVET,
I just returned from taking my 6 year old Lab/Rottie mix to the vet for what I thought was an eye injury. He was diagnosed with Horner's. I've never heard of it, so I immediately came home and got online to read all that I could on the disease. However, in my reading I began to think of why? Over the last 3 months, he has been diagnosed with COPD, brought on by allergies.(Or so we think, we rescued him just a little over 2 years ago, and he had very bad seasonal allergies) He has had chest, cervical and abdominal x-rays, all were normal. However, he didn't have any lab work done, other than a heartworm test, which was negative. He has been on Theophylline 200mg twice a day, Lasix 60mg twice a day, Prednisone 20mg twice a day (which we have been VERY SLOWLY weaning down) and also takes Zyrtec once a day. My question to you is that since Lasix and Prednisone can lower T3 & T4 levels, could there be a possible correlation between hypothyroidism and Horner's? I have left a message at the office for my vet, but I have not yet heard back from him.
Thank you,
Sue

Anonymous said...

Hi there,
My chocolate labrador has Horners Syndrome which was diagnosed in early December 2013. Still has it and I am putting the drops in twice a day to try to reverse it. On application of the drops the pinkness and appearance of the eye does seem better and seems to last until the next drop is placed. No real improvement yet. However my concern is that she now appears to be deaf! She was also prescribed ear drops at the same time which lasted for a week. Not only does she not appear to be able to hear anything and I have done lots of clapping loudly which she does sometimes seem to hear but trying to walk her has become a big problem. She will walk out for maybe five minutes then refuses to move. I can literally only get her to walk back home by motivating her to receive treats. It's very worrying because she happily potters around the house ok and can also do the stairs with minimal assistance. She lost her brother, same breed who was 14 and a half when he passed over. This happened last August and was her best buddy. Do you think any of this is connected at all. I am more concerned about the walking at the moment as I can't think of a reason other than she is giving up on life since she lost her brother. She is 12 years, 13 in March 2014. Please any advice would be welcome. She has had elbow displasia in her right front for a few years and does groan a little on sitting etc but nothing that I am not familiar with. She just is not seeming to want to move when out, hence hardly walking her at the moment as it is very stressful for me when I can't get her to actually walk far. She does potter in the garden. Thank you.

Anonymous said...

I have a 10 y/o Black Lab who may have Horner's. She is exhibiting all the symptoms you have described. This all, coincidentally, occurred when we found out she was suffering from a UTI and a fever. She was also diagnosed with diabetes, so is now on two antibiotics for the infection, and two shots of insulin daily. Is it just coincidence that the left eye first started like this at the sme time as the infection, and now the right eye is doing it?

Cliff Mardinger said...

There is no correlation between a urinary tract infection and Horner's syndrome. However, diabetic patients are susceptible to any type of infection and that could include a middle ear infection. A good look in her ears should be performed and radiographs of her tympannic bullae should be considered to rule this out. A free T4 by equilibrium dialysis (blood test) should be performed to ensure the dog is not hypothyroid. Again, most cases of Horner's syndrome are idiopathic - no discernible cause!

Anonymous said...

This blog has been so helpful to me after my 6 year old yellow lab has been diagnoised with Horners. Here symptoms are the drooping eye drooling and sounded congested all on the same side of her face. The vet did blood work which came out fine. She does have history of seizures but not on medication due to the frequency of her seizure aprx every 6 weeks or so. She also has been itching her ears and doing a lot of head shaking. She is on a tie out leash for bathroom breaks and does pull her chain often when the neighbors kids tend to try and tease her. At any rate the vet put her on predispose on 3 week taper. Being a single fur parent I too am unable to afford all the tests and pray that this will resolve on its own over time. My Angel is my best friend after my daughters grew up and move on Id be devastated to loose her at such a young age. If time doesn't help I have thought of taking a loan for the middle ear testing due to the signs she's shown of scratching and head shaking plus when the vet checked her ears she whined although he couldn't see anything. Your suggestions would be greatly appreciated and thank you in advance with Horners. Here symptoms are the drooping eye drooling and sounded congested all on the same side of her face. The vet did blood work which came out fine. She does have history of seizures but not on medication due to the frequency of her seizure aprx every 6 weeks or so. She also has been itching her ears and doing a lot of head shaking. She is on a tie out leash for bathroom breaks and does pull her chain often when the neighbors kids tend to try and tease her. At any rate the vet put her on predispose on 3 week taper. Being a single fur parent I too am unable to afford all the tests and pray that this will resolve on its own over time. My Angel is my best friend after my daughters grew up and move on Id be devastated to loose her at such a young age. If time doesn't help I have thought of taking a loan for the middle ear testing due to the signs shes shown of scratching and head shaking plus when the vet checked her ears she whined although he couldn't see anything. Your suggestions would be greatly appreciated and thank you in advance

Anonymous said...

Hi Left a comment a few days ago n keep checking back for a response but haven't seen on yet :(. We are on the third day of prednisone, for vet diagnosed Horners. I did see improvement in her a the second day and hoping for more plus she did shake a bit a of black tarry subsistence from her ears. Any suggestions???? should she be on antibiotics too? Thank you in advance worried fur parent

Cliff Mardinger said...

To the last two "Anonymous" posts:
1) I betcha a million bucks that your dog has primary allergies and a secondary middle ear infection (or trauma to the middle ear from so much scratching and shaking).
Even if the outer ear canal looks clean, this does NOT preclude otitis media.
Let your vet talk to you about allergy testing and a food trial, but this dog should be on steroids, antibiotics, and an antifungal agent (like fluconazole) for good measure.

2) Sorry I didn't get back to you sooner. I did not see your 1st post.
The black tarry substance is most likely a yeast infection, HOWEVER, a cytology of the "gunk" should be done. That would guide therapy. See above under "Anonymous 1." I would never prescribe JUST prednisone with Horner's syndrome. If there is an underlying infection, and in this case there is, the prednisone would allow the infection to get worse. I would either prescribe nothing, or prescribe prednisone and antibiotics and/or fluconazole (have the vet do an ear cytology - it's so important). Your dog likely has allergies, too.

Jessica Lucas said...

Hi,
My 8 year old cat had all of his back teeth pulled on both sides 5 days ago. The teeth were in bad shape and apparently the extractions were easy. Ever since he came home he has been exhibiting Horner's and that's what the vet suspects but it's not quite an exact fit for Horner's syndrome. I'll describe it: His left eye and pupil are reactive and appear normal but possibly slightly sunken (with normal eye pressure 14). His right eye has the droopy upper lid, and a LARGE dilated pupil (which doesn't seem to fit Horner's). This right eye is slightly protruded in the socket and has higher pressure (20) than the normal eye. The dilated pupil does not respond to light at all and that eye can move side to side but cannot look up in the socket. He can close it fully but it is painful to touch while the other is not. The third eyelid was present on this dilated eye but has since disappeared. He is visual in both eyes and the retinas look fine. The mouth is also healing well. The vet is not totally sure what's going on. I have a feeling it is from how the painkillers were injected on that side. Not sure what to do. Will this clear up? Are his nerves damaged? Is this just swelling that will go away? Not really sure how to proceed. The enlarged pupil on the "wrong" eye, lack of pupil response to light, and limited eye movement concern me. Thank you!

Cliff Mardinger said...

Jessica,

This is NOT Horner's syndrome. Horner's syndrome is not painful and does not cause a dilated pupil. This sounds like a retrobulbar abscess and/or early glaucoma to me. I'm more suspicious of the former. Clindamycin at 11-15 mg/kg twice daily should be started right away, along with pain medication. KEEP ME POSTED and good luck.

Jessica Lucas said...

Thank you for the insight Cliff. He was on that dose of Clindamycin for about a week after and the eye problem appear promptly after the dental. Would an abscess form that quickly? Also when I say bulge, it's not a crazy bulge at all. The vet consulted a dental specialist, 2 ophthalmologists, and a neurologist. Special eye drops showed the dilated problem pupil will constrict and the signals to the brain appear to be working fine when that test was done. No one could say for sure what it is, they were all stumped actually. But they think it will subside over time. The neurologist suggested his mandibular artery was compressed during the procedure. He does shake his head and his ears, sinuses bother him slightly. But that was going on before the dental. Really mysterious. Clearly something during the dental caused it. Not sure how to proceed.

Anonymous said...

I have a five year old Golden Retriever whose lower eyelids in BOTH eyes spontaneously started to droop two days ago exposing the third eyelids. We met with a vet today, but she was unsure what's happening, so we have a ophthalmologist visit in a week and half, which seems like an eternity to me. I wish I could attach a photo (he looks so sad!!) to get your opinion. He has dark eyes, so I can't really see the pupils, and his eyes don't really appear sunken to me. The droop is intermittent, usually presenting when he is tired or relaxed. He's been a pretty healthy dog, no ear infections to speak of, except for a spontaneous pneumothorax a few years ago, which was addressed surgically. If it is NOT Horner's that we're dealing with, can you tell me some other possibilities that I can research?

Cliff Mardinger said...

Jessica,

If not an abscess, then bleeding from an extraction to the retrobulbar space is another top thought of mine. It should go away if this is what happened.
Anon, upper eyelids droop with Horner's syndrome. Facial paralysis, cranial nerve VII pathology, can cause the symptoms you're describing. This could be idiopathic (no obvious underlying cause), due to hypothyroidism, or other underlying issues. Are his lips drooping too? Opening and closing mouth ok? Ability to blink? Please keep me posted.

Ken Miller said...

Thanks for an excellent blog, I am looking for some guidance. My basset who is 10 was diagnosed with Horner's in his left eye about 2 years ago. The prescription was to give him normal eye drops three times a day, which I have been doing for some time. The eye did not seem to hurt, normally looks kind of gooey around the base.

He also has had a Pseudomonas infection in his left ear for almost 4.5 years. The vet has tried antibiotics, BNT deep cleaning under sedation, etc. We have him in ever few month for an ear cleaning. I suspect that the Horner is a side cause to his ear problems.

This evening, when we got home, however, something was obviously wrong. Bosley was not his normal self, happy to see us, barking and excited. He was very subdued, put him out for bathroom, and fixed his dinner, he came back in, ate only the slice of turkey off the top and sort of followed us around, looking afraid.

Noticed that his right eye's third eyelid is now showing dramatically, which leads us to think he cannot see much now, somewhat restless. It appears that there is a bit of puffiness above both eyes.

He stayed close to me while I petted him, gave him another slice of turkey, and he ate that fine, but did not touch the dry food. We have, on the vet's advice been giving him two benedryl night and day to ease the discomfort from the ear. We got his benedryl down with no problem, dropped his eyes, but I really don't know what else to do.

He is normally a fairly happy dog, but tonight, he is very subdued, managed to get him to lay down on his bed which is where he is now. He is not an active dog, spending most of his day alone and sleeping, we assume, and most recently, he has taken to sleeping most of the night.

I'd appreciate any suggestions, since it is a Saturday, the vet's office is not open.

Thanks again
Ken

Cliff Mardinger said...

Ken,

I am replying on Monday so I assume you called your veterinarian by now. In this case, there is something acute going on, and something chronic.
The chronic is likely underlying allergic skin disease (food allergies and/or atopy). A dog should not have a Pseudomonas otitis for 4.5 years. That said, it is highly suspicious that he has now developed otitis media from his chronic otitis externa.
The dog should have otic/ear exam performed under heavy sedation or general anesthesia. X-rays of the tympanic bullae should be performed. The best view being the one where the patient has his mouth open and the x-ray beam shot down into the mouth (the tympanic bullae are best seen on this view). CT scan should be considered, even if the radiographs are normal. I suspect they won't be, though. Clindamycin or fluorquinolone should be considered for upwards of 8 weeks. Along with an anti-inflammatory dose of prednisone. If the bullae are abnormal, surgery to drain the tympanic bullae should be considered. Discuss these things with your veterinarian and please keep me posted. Good luck!

Ken Miller said...

Cliff:

Many thanks for your time and thoughts, I am printing them out when we go to the vet.

Sorry to be slow in responding, but after I wrote, I managed to get him to fall asleep, where he slept solid for about 8 hours, when he awoke, he was pretty much back to normal, happy, ready to go out, tail wagging, third eyelid gone down to back in place. There seemed to be no issues, and it is not always easy to get him to the vet, so I said I'd wait for now.

Then on Tuesday night, same problem has flared up again. So this morning, Wednesday, I have a call into the vet.

When Bosley's ear problem first started, I had just hurt my back, and was unable to bend enough to do any cleaning or wrestling with him. Since then, I have been taking Bosley to the vet, every few months, where they will put him under, and clean his ears, put in the BNT, and have frequently had him on antibiotics.

Over a year ago, the vet said he did not know what else to do, but offer a referral to the Virginia Tech Vet School and possibly an ear ablation. This bothered me on several points, first was the expected cost, about $2,000, second the fact that he had an infection that nothing seemed to stop. And doing surgery with a bad infection just seems like a potential for creating more problems.

They had done cultures on the ear, and determined that the best antibiotic at those times was ciproflaxin which they have prescribed a number of times. They would also do a course of Prednisone.

His ear will seem to be fine for some period of time, not smelly or itchy, sometimes for a few weeks, sometimes for a few months. It did not seem to matter if it was a course of antibiotics or not.

We changed his food a few years ago to a grain free but it seems like that had little, if any effect. The vet suggested to keep his itching down, to give him two benedryl, twice a day. It is hard to tell if it helps or not.

Bosley is primarily an inside dog, only out to walk occasionally, and normal bathroom trips, but rarely much otherwise. We adopted him as a owner surrender at age two. His first owner died when he was about a year old, her sister kept him (badly) until she was ready to move into assisted living. I don't think he was well treated his second year, not properly fed, if not out and out abused. I really don't think they cared about him at all, to be honest. At the time we adopted him, the owner said he had some ear problem, no real information, but his (then) vet would not share any information. I mentioned it to our vet. Bosley is my second basset, my first went to the bridge in 2002. We adopted Bosley two weeks after we got married in 2006.

Before I was done, the vet called, no real good suggestions. So the plan is to drop Bosley off there first thing tomorrow and she can check eye pressure, inflammation on the third eyelid, and more. I am also going to leave her a print out of your comments. She is pretty open, so I think she will see what she can do.

Again, many thanks for your comments, sharing your knowledge and listening.

Best
Ken

Cliff Mardinger said...

Ken,

Grain-free diets are not necessarily the solution. While dogs and cats can certainly be allergic to grains, they are rarely the culprit. Ask your veterinarian for a hydrolyzed protein diet such as RC Hypo HP,RC Anallergenic, Hill's z/d Ultra, or Purina HA. You need a 3 month trial of most of these diets to see if the dog has a food allergy. Do NOT use anything store-bought! I would also invest in the HESKA serum environmental allergy panel. It's not 100% but could help determine if the dog has ENVIRONMENTAL allergies - then your vet can start immunizing him! Oh, and if I haven't mentioned it already, your dog's thyroid function must be checked. Good luck!

Catherine Stewart-Mott said...

Oddly, I have read TONS of posts about Horner's Syndrome, and went to vet's office where several vets took a look at my pooch's eye. About nine months ago, it was suggested that is was likely Horner's Syndrome and not to worry too much. Then around Christmas (2014) it started looking worse. I had her on Baytril for a long run thinking it might knock out a possible inner ear infection (she would shake her head when barking at strangers repeatedly). After we stopped those meds, the eye continued to get worse looking (and did not improve during the meds). She still shakes her head when barking enthusiastically. Eats well, nothing off otherwise but I feel as if the eye itself is now looking 'tender and possibly infected'. Worried it could be a tumour, and 'one vet' at the office questioned that in January. Sigh. Probably a trip back to the vets in is order. (She is 10 year old husky/malamute/mutt mix in otherwise good health although there is arthritis setting in.

Anonymous said...

Hi, My 9 year old golden retriever girl Jenny just got diagnosed with post-ganglionic Horner's syndrome on her left eye. We started a course of antibiotics to treat her potential inner ear infection. However, 5 days later her right eye showed the same symptoms (haven't seen ophthalmology on this eye yet, but saw our general veterinary doctor), with redness in both eyes. We got chest, neck and skull x-rays to look for tumors and inner ear decease. Everything came out clean except that her throat seems to be swelling. She's gaging a little from time to time, mostly when we are outside taking a walk, Im not sure its from her nose or throat, otherwise she is behaving normally. We started a triple antibiotic course and an eye ointment with steroid. Three days later (which is today), her right eye looks worse, 2/3 of the eye is covered by her 3rd eyelid. Both her general doctor and her ophthalmologist are really puzzled.

She has a history of seasonal allergy, usually on her skin. This year has been pretty good, no hot spot yet. She had one tick bite back in April and she's been wearing a long lasting tick collar ever since, I haven't found another one. She had one mass cell tumor on the base of her tail, the tail was amputated with clean margin. The tumor turned out to be grade I. 4 months later we found 2 more mast cell tumors, one on her thigh, one on her back, both removed with clean margin, pathology came back both grade I. The latest surgery was performed 7 months ago.

Please help me, I can't find much about bilateral horner's syndrome online. Her ophthalmologist told us its very likely idiopathic when we first got diagnosed. As more symptoms are discovered she's not sure anymore...

Cliff Mardinger said...

Catherine, most cases of Horner's are idiopathic. That said, I'm concerned about the "swelling" you noted. Firstly, is there or isn't there swelling? If yes, the dog might have a retropharyngeal abscess or tumor in the throat area. The throat is linked to the middle ear via the eustachian tubes. This is the only link I can make between throat disease (abscess/tumor) and Horner's.
Radiographs of the throat and CT of the skull are indicated at this point. Good luck!

Cliff Mardinger said...

Anonymous, it sounds like Jenny has two unrelated issues: Horner's and allergies. One does not cause the other. The redness in the eyes is likely related to allergies, called allergic conjunctivitis, though your vet should certainly corroborate this. Most cases of Horner's in dogs are idiopathic, but other causes should be ruled out. I discuss these in my posts. Good luck!

Judy said...

My 8 yr old lab has had allergies and an inlet eyelid all his life. He takes benadryl. His eye has now sunk into his head, is red and he is breathing through his mouth all the time, and rubbing his eye. Would this be horners?

Cliff Mardinger said...

I don't know what an "inlet" eyelid is. All dogs and cats have a nictitans or 3rd eyelid (one per eye).
Horner's should not cause breathing problems and allergies don't affect a single eye. Both eyes would be itchy.
Horner's will cause a sunken eye, though, as well as a visible and protruding 3rd eyelid. Don't try to diagnose this yourself. Go see your vet asap!

Joyce said...

I just found this blog and agree with others that it is excellent. My 12 (almost 13) year old golden retriever began having mild seizures in December 2013. He has had 5 other similar seizures (that I know of) since then. His seizures involve no thrashing of limbs, etc. He collapses, trembles and stares into space for approximately 2 or 3 minutes, then is totally normal after another minute or 2. He is currently on no medication for the seizures. This past June (2015), I took him to our regular vet for some eye changes that I had noticed, first with the right eye, then the left. He referred me to an ophthalmologist. He was diagnosed with Horner's in his right eye, which is very mild (not much 3rd lid involvement and just a barely noticeable droop of the lower lid) which probably began 6 months earlier. At the time I took him to the ophthalmologist, he also began exhibiting signs of something going on with his left eye as well. The upper lid has dropped a bit, and our regular vet felt there was decreased motion in that eye. The slightly dropped lid is definitely noticeable upon looking at him. The ophthalmologist also examined that eye as well, but did not diagnose it as Horner's. Even after 9 months, the Horner's eye has cleared up slightly, but not totally. The left upped lid remains slightly dropped, and we feel that he now turns his head more in order to be able to see us better out of that eye. We are concerned the eye issues may be related to or a result of the seizures. The left eye is what now has us concerned the most, and that, in conjunction with the seizures makes us afraid there may be a brain tumor. Other than the sporadic seizures and the eye issues, he is a totally healthy, happy, fit golden. We have decided to take him for an MRI at the city teaching hospital tomorrow. I guess we will know more then, but would appreciate any input you may have.

Cliff Mardinger said...

I am so sorry to hear this news. My first concern is an intra-cranial lesion (scar, tumor, etc), especially given the dog's age. The MRI is of course the way to go. Please let us know how things went with the MRI. Take care.