Horner Syndrome as a Rare Complication Following Parathyroidectomy: A Case Report

Authors

DOI:

https://doi.org/10.48560/rspo.38220

Keywords:

Horner Syndrome/etiology, Parathyroidectomy/adverse effects, Postoperative Complications

Abstract

Horner syndrome arises from disruption of the oculosympathetic pathway, presenting with ptosis, miosis, and hemifacial anhidrosis. It is a rare complication following parathyroid surgery. A 64-year-old female developed right upper eyelid ptosis 24 hours after a right superior parathyroidectomy a year earlier. Histopathology confirmed a parathyroid adenoma. Ophthalmological examination revealed right-sided miosis, with delayed pupillary dilation under scotopic conditions. No hemifacial anhidrosis was noted. Diagnosis was confirmed through apraclonidine test. Surgery for reinsertion of the right upper eyelid retractors resolved the ptosis. The anisocoria persisted. This case underscores the importance of recognizing Horner syndrome as a rare complication following parathyroid surgery. General surgeons should be aware of the oculosympathetic pathway’s vulnerability. A comprehensive clinical history and ophthalmological examination are crucial for identifying potentially serious neurological conditions.

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References

Crippa SV, Borruat FX, Kawasaki A. Pupillary dilation lag is intermittently present in patients with a stable oculo-sympathetic defect (Horner syndrome). Am J Ophthalmol. 2007;143(4):712-5. doi: 10.1016/j.ajo.2006.10.049

Nielsen PJ. Upside down ptosis in patients with Horner’s syndrome. Acta Ophthalmol. 1983;61:952-7. doi: 10.1111/j.1755-3768.1983.tb01480.x

Barrea C, Vigouroux T, Karam J, Milet A, Vaessen S, Misson JP. Horner syndrome in children: a clinical condition with serious underlying disease. Neuropediatrics. 2016;47:268-72. doi: 10.1055/s-0036-1584085

Davagnanam I, Fraser CL, Miszkiel K, Daniel CS, Plant GT. Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm. Eye. 2013;27:291-8. doi: 10.1038/eye.2012.281

Basic and Clinical Science Course, Section 5: Neuro-Ophthalmology 2023-2024. San Francisco: CAAmerican Academy of Ophthalmology; 2024.

Sociedade Portuguesa de Oftalmologia. Neuroftalmologia Baseada na Evidência.Lisboa: Sociedade Portuguesa de Oftalmologia; 2021.

Tang M, Yin S, Yang Z, Sun Y, Chen H, Zhang F. Horner syndrome after thyroid-related surgery: a review. Langenbecks Arch Surg. 2022;407:3201-08. doi: 10.1007/s00423-022-02636-z

Mahoney NR, Liu GT, Menacker SJ, Wilson MC, Hogarty MD, Maris JM. Pediatric horner syndrome: etiologies and roles of imaging and urine studies to detect neuroblastoma and other responsible mass lesions. Am J Ophthalmol. 2006;142:651-9. doi: 10.1016/j.ajo.2006.05.047

Carsoie M, Nistor CE, Popa FL, Stanciu M. Horner’s syndrome and lymphocele following thyroid surgery. J Clin Med. 2023;12:474. doi: 10.3390/jcm12020474

Harding JL, Sywak MS, Sidhu S, Delbridge LW. Horner’s syndrome in association with thyroid and parathyroid disease. ANZ J Surg. 2004;74:442-5. doi: 10.1111/j.1445-1433.2004.03030.x

Allen AY, Meyer DR. Neck procedures resulting in Horner syndrome. Ophthalmic Plast Reconstr Surg. 2009;25:16-8. doi: 10.1097/IOP.0b013e318191febf

McCrory D, Kelly A, Korda M. Postoperative Horner’s syndrome following excision of incidental cervical ganglioneuroma during hemithyroidectomy and parathyroid gland exploration. BMJ Case Rep. 2020;13. doi: 10.1136/bcr-2019-231514

Solomon P, Irish J, Gullane P. Horner’s syndrome following a thyroidectomy. J Otolaryngol. 1993;22:454-6.

Villalonga R, Fort JM, Mazarro A, Gonzalez O, Caubet E, Romero G, et al. Postthyroidectomy Horner’s syndrome. Case Rep Med. 2012;2012:316984. doi: 10.1155/2012/316984

Gonzalez-Aguado R, Morales-Angulo C, Obeso-Agüera S, Longarela-Herrero Y, García-Zornoza R, Ade Cervera L. Horner’s syndrome after neck surgery. Acta Otorrinolaringol Esp. 2012;63:299-302. doi: 10.1016/j.otorri.2012.01.015

Morales J, Brown SM, Abdul-Rahim AS, Crosson CE . Ocular effects of apraclonidine in Horner syndrome. Arch Ophthalmol. 2000;118:951-4.

Maloney WF, Young BR, Moyer NJ. Evaluation of the causes and accuracy of pharmacologic localization in Horner’s syndrome. Am J Ophthalmol. 1980;90:394-402. doi: 10.1016/s0002-9394(14)74924-4

Mughal M, Longmuir R. Current pharmacologic testing for Horner syndrome. Curr Neurol Neurosci Rep. 2009;9:384-9. doi: 10.1007/s11910-009-0056-z

Almog Y, Gepstein R, Kesler A. Diagnostic value of imaging in horner syndrome in adults. J Neuroophthalmol. 2010;30:7-11. doi: 10.1097/WNO.0b013e3181ce1a12

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Published

2025-09-16

How to Cite

Maia, F., Vaz Pereira, M., & Azenha, C. (2025). Horner Syndrome as a Rare Complication Following Parathyroidectomy: A Case Report. Revista Sociedade Portuguesa De Oftalmologia. https://doi.org/10.48560/rspo.38220

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Section

Case Reports