Horner’s Syndrome Mnemonic [Easy to remember]

There are few things more satisfying than diagnosing Horner’s Syndrome on a ward round — unless, of course, you’ve just drawn the perfect ABG on the first try. 😉

In my time rotating through the General Medicine and CCU departments at Sheikh Khalifa Bin Zayed Hospital, I’ve seen Horner’s sneak up in all kinds of cases — from Pancoast tumors to carotid dissections. Subtle signs, big implications.

Let’s make it stick with a classic mnemonic to remember the components of Horner’s Syndrome: SAMPLE 🧠

Mnemonic Table: Horner’s Syndrome — “SAMPLE”

Letter	Feature	Explanation
S	Sympathetic chain injury	The root cause — interruption anywhere from hypothalamus to eye. 🧬🛑
A	Anhidrosis	Loss of sweating on the affected side of the face. Dry and not in a good way. 💦🚫
M	Miosis	Constricted pupil due to unopposed parasympathetic tone. Pupillary politics. 👁️📉
P	Ptosis	Droopy eyelid thanks to Müller’s muscle losing its sympathetic support. 💤👁️
L	Loss of ciliospinal reflex	Normally, pinching the neck dilates the pupil. Here? Nothing. The pupil just stares at you. 😐📎
E	Enophthalmos	Sunken eyeball — though more often perceived than real. Optical illusion 101. 🎩🔍

🩺 My Clinical Take (Straight from Quetta)

I remember a young man with neck trauma post-road accident — normal CT brain, no visual complaints, but the left pupil was noticeably smaller with mild ptosis. That moment when your med student says, “Sir, I think it’s Horner’s,” and you don’t need coffee for the next 6 hours.

We traced it back to a carotid dissection — caught early, managed well. Moral of the story? Always check the eyes. The ANS never lies.

🧠 Clinical Tips

Horner’s is often missed because it’s not dramatic. Look for subtle ptosis and miosis, especially in neck trauma, apical lung tumors, or surgical patients post-neck dissection.
If you’re still not sure, instill apraclonidine — it reverses the anisocoria in Horner’s. Like pharmacologic magic. 💧

HAPPY LEARNING, folks! 🙂

Signing off,

Dr. Aurangzaib Qambrani
(MBBS, PLAB, MRCP-UK 1)
Sheikh Khalifa Bin Zayed Hospital Quetta