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Warning-sign checks

Horner syndrome: when to get help

Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.

  1. 1

    Is any of this happening now?

    Call 911

    Seek emergency medical care for newly developed unequal pupils or eyelid drooping with:

    • Sudden neck, head, eye, or facial pain
    • Weakness or numbness on one side
    • Trouble speaking, swallowing, walking, or staying balanced
    • A sudden severe headache
    • New double vision or loss of vision
    • Recent significant head or neck injury

    These combinations can occur with a carotid artery dissection, stroke, or another condition needing rapid assessment.

    Do not drive yourself if you have possible stroke symptoms.

    Other emergency signs, for anyone
    • Someone who is struggling to breathe, gasping, choking, or cannot get words out
    • Someone who has chest pain, tightness or pressure lasting more than a few minutes
    • Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
    • Someone who is unconscious, or cannot be woken
    • Someone who is bleeding heavily and it will not stop with firm pressure
    • Someone who has had a seizure that will not stop, or does not wake up afterwards
    • Someone who has lips or skin that look pale, blue, grey or blotchy
    • Someone who you believe has taken an overdose or swallowed something poisonous
  2. 2

    Is any of this happening?

    Be seen today

    Arrange urgent medical assessment for a new small pupil and drooping eyelid even if there is no pain, especially when the time of onset is clear.

    A child with newly noticed Horner signs should also be assessed promptly.

  3. 3

    Does any of this apply?

    Book an appointment

    Routine follow-up is appropriate for diagnosed, stable Horner syndrome when no new symptoms have appeared.

    Bring forward the appointment if the eyelid droop changes, sight becomes affected, or other neurological symptoms develop.

Every sign above is quoted from the sofidex article on Horner syndrome. If you are not sure, err upward — it is always reasonable to be checked.