Q&A: Rating Horner Syndrome

Abstract

QUESTION: How is Horner syndrome rated?ANSWER: Horner syndrome is a relatively rare, usually unilateral disorder characterized by a constricted pupil (miosis), drooping of the upper eyelid (ptosis), and absence of facial sweating (anhidrosis). It results from disruption of the sympathetic nerve supply to the face, including the eye. The neural disruption can be caused by many different diseases and injuries, both congenital and acquired, and some cases are idiopathic.The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address Horner syndrome. However, in the sixth edition, ptosis can be rated using Table 11-5, Criteria for Rating Impairment due to Facial Disorders and/or Disfigurement (6th ed, 262), as explained in Section 11.3a, Criteria for Rating Impairment due to Facial Disorders and/or Disfigurement (6th ed, 261-265). Usually, Horner syndrome does not result in significant visual impairment. However, Chapter 12, The Visual System, Section 12.4b, Individual Adjustments (6th ed, 305-306), explains considerations for other functions. In the unlikely event the ptosis is of sufficient severity to restrict the visual field, that impairment can be rated. Because miosis often helps correct visual acuity deficit from astigmatism, there is usually no visual acuity loss from Horner syndrome.