Neurotrophic corneal endothelial failure complicating acute Horner syndrome.
OBJECTIVE
The authors report the clinical findings of a unique case of rapid corneal endothelial decompensation in association with acute Horner syndrome.


METHODS
Case report and literature review.


METHODS
The authors followed a 38-year-old woman who developed Horner syndrome after right jugular vein catheterization during cardiac valvular surgery. Shortly after the operation, Horner syndrome accompanied by conjunctival hyperemia and stromal corneal edema developed in the right eye. Over the course of 4 months, the eye became painful, the corneal endothelial cell count dropped precipitously, and the stromal edema worsened, causing a difference of 100 microm in central corneal thickness compared to the unaffected eye. Deep stromal vascularization started at the limbus, resembling interstitial keratitis.


RESULTS
A 3-week course of topical steroid treatment resulted in a dramatic improvement in the stromal corneal edema and regression of the deep stromal vascularization. Ocular and right hemicranial pain subsided shortly thereafter.


CONCLUSIONS
The authors hypothesize that corneal endothelial failure in this unique case may have resulted from traumatic sympathectomy. According to experimental evidence in the reviewed ophthalmologic literature, sympathetic innervation may have a neurotrophic role in the cornea. Corneal pathology similar to the authors' case has been described in hemifacial atrophy (Parry-Robson syndrome), a disorder that is assumed to result from sympathetic denervation and that can be produced in animals by cervical sympathectomy. The authors therefore hypothesize that sympathetic denervation of the cornea may rarely cause endothelial decompensation and corneal edema. To the authors' knowledge, this is the first reported case of corneal endothelial failure in Horner syndrome.
Zamir
E
E
Hadassah University Hospital, Jerusalem, Israel. zami@md2.huji.ac.il
Chowers
I
I
Banin
E
E
Frucht-Pery
J
J
D000208:Acute Disease; D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002405:Catheterization, Central Venous; D002452:Cell Count; D003229:Conjunctival Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D003316:Corneal Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D015715:Corneal Edema / Q000209:etiology / Q000473:pathology; D003319:Corneal Stroma / Q000294:innervation / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005938:Glucocorticoids; D006732:Horner Syndrome / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006940:Hyperemia / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D008775:Methylprednisolone / Q000627:therapeutic use; D013564:Sympathetic Nervous System / Q000293:injuries
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008775:Methylprednisolone