Abstract
Purpose :
Horner syndrome (HS), known classically by its presenting triad of miosis, eyelid ptosis, and facial anhidrosis, results from damage to sympathetic pathways. Prompt diagnosis of HS is critical given the potential high morbidity and mortality associated with underlying pathologies such as major artery dissection or tumor. To our knowledge, this study is the first to analyze clinical practice patterns and adherence to a neuro-ophthalmic protocol (Trobe) to evaluate for HS.
Methods :
A retrospective chart review was conducted on patients formally diagnosed with HS (ICD-10 code G90.2) between 2016-2022. Each patient’s presenting visit and clinical course was evaluated. Data elements beyond patient demographics included site and urgency of initial presentation, diagnostic assessments performed, and subsequent clinical course. Imaging studies performed were furthermore recorded and assessed for diagnostic yield. Descriptive statistics were performed.
Results :
Patients diagnosed with HS (N=77) had a mean age of 58.4 +/- 23.3 years, with 32.5% identifying as male and 67.5% female. The majority of cases were diagnosed as idiopathic (40%) and iatrogenic (36%), and the remaining 24% a mix of fourteen other etiologies (Figure 1). Notably, acute major artery dissection (5%) and known trauma (3%) accounted for a fairly small proportion of the total number of cases. A large percentage of patients received diagnostic imaging (45.5%), many of whom were found to have localizing lesions (37.1%).
The largest proportion of patients initially presented to Ophthalmology (40.2%), followed by Neurology (31.2%), Primary Care/Pediatrics (15.6%), surgical specialties (6.5%), ED/Critical Care (3.9%), and other (2.6%). The adherence rate to the protocol was 26% and increased to 70.1% when apraclonidine testing was omitted. Of the remaining 29.9% whose work-up deviated from the diagnostic protocol, the majority (91.3%) were related to either absent or redundant imaging studies.
Conclusions :
Patients diagnosed with Horner Syndrome were most likely to present to Ophthalmology and Neurology clinics, however a large proportion of these patients did not receive apraclonidine testing as per neuro-ophthalmic protocol (Trobe), suggesting further assessment is warranted. Localizing lesions were found in over a third of imaging studies performed. The vast majority of cases were found to be either iatrogenic or idiopathic.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.