A case of congenital Horner syndrome from the 16th century.

Abstract

Horner syndrome,1Horner F Über eine form of ptosis.Klin Monatsbl Augenheilkd. 1869; 7: 193-198Google Scholar also known as oculosympathetic paresis, occurs as a result of an interruption of the ocular sympathetic nerve supply to the pupils and the eyelids. It is characterised by the triad of unilateral ptosis, reactive ipsilateral miosis, and hemifacial anhidrosis.2Kanagalingam S Miller NL Horner syndrome: clinical perspectives.Eye Brain. 2015; 7: 35-46PubMed Google Scholar, 3Jeffery AR Ellis FJ Repka MX Buncic JR Paediatric Horner syndrome.J AAPOS. 1998; 2: 159-167Summary Full Text PDF PubMed Scopus (106) Google Scholar The oculosympathetic pathway consists of three neurons: the central neuron, the preganglionic neuron, and the postganglionic neuron. Lesions can manifest anywhere along this pathway, giving rise, respectively, to first order, second order, and third order Horner syndrome. The disorder can be either congenital or acquired.2Kanagalingam S Miller NL Horner syndrome: clinical perspectives.Eye Brain. 2015; 7: 35-46PubMed Google Scholar, 3Jeffery AR Ellis FJ Repka MX Buncic JR Paediatric Horner syndrome.J AAPOS. 1998; 2: 159-167Summary Full Text PDF PubMed Scopus (106) Google ScholarWe report a case of congenital Horner syndrome in a 16th century portrait (figure) from the collection of the Archduke Ferdinand II of Tyrol (1529–95), which is displayed in the Kunsthistorisches Museum (Vienna, Austria). No information is available about the artist or the sitter; however, based on the higher court clothing, we surmise that the portrayed man belonged to a noble family. The sitter displays mild ptosis, ipsilateral miosis in the right eye, anisocoria, and pseudoenophthalmos, in addition to heterochromia iridis,2Kanagalingam S Miller NL Horner syndrome: clinical perspectives.Eye Brain. 2015; 7: 35-46PubMed Google Scholar, 3Jeffery AR Ellis FJ Repka MX Buncic JR Paediatric Horner syndrome.J AAPOS. 1998; 2: 159-167Summary Full Text PDF PubMed Scopus (106) Google Scholar a typical feature of paediatric Horner syndrome.2Kanagalingam S Miller NL Horner syndrome: clinical perspectives.Eye Brain. 2015; 7: 35-46PubMed Google Scholar, 3Jeffery AR Ellis FJ Repka MX Buncic JR Paediatric Horner syndrome.J AAPOS. 1998; 2: 159-167Summary Full Text PDF PubMed Scopus (106) Google Scholar We surmise that the sitter was affected by Horner syndrome in his right eye as a child. This disorder is most often localised in the preganglionic or second order neuron, whereas the first order and third order neurons are almost exclusively affected in adults.2Kanagalingam S Miller NL Horner syndrome: clinical perspectives.Eye Brain. 2015; 7: 35-46PubMed Google Scholar, 3Jeffery AR Ellis FJ Repka MX Buncic JR Paediatric Horner syndrome.J AAPOS. 1998; 2: 159-167Summary Full Text PDF PubMed Scopus (106) Google Scholar Whether the cause of the sitter's syndrome was due to birth trauma, was post viral (ie, viral encephalitis), or was idiopathic cannot be ascertained in the absence of historical records. We declare no competing interests.