Horner’s Syndrome?

Hello Vets! I would be really grateful for your help. My 5.5 year old dog has been having intermittent issues with her right eye since November. The blue “ring” (third eye lid) starts to show, she has difficulty opening her eye, it is often red, and has light watery discharge. The first time it happened in November, it was accompanied by an inability to shake her head, turn on her back, extreme lethargy, pain, nodding off, and slow walking. It was terrifying and we thought she wouldn’t survive. She didn’t want to be touched on her face/head and the neck seemed extremely sensitive as well. The vets did not medicate her, and she was back to better in 2-3 days. Her bloodwork (CBC, PCR and Electrolyte Panel), chest X Ray, ECHO and ECH were normal. On December 20th, she was again unable to open her right eye, had redness and was lethargic and weak. Her iOPH in the right eye was 14 mmgh (ref: 15-25) and in the left was 23 mmgh. Her eye went back to normal in 7-8 hours. Today, Feb 5th, she has been unable to open her right her eye again. It’s been 7-8 hours already. There are times in between when she can open it completely for a few minutes but again goes back to not being able to. Our primary vet said it is Horners but an opthalmologist vet we consulted remotely said it doesn’t seem like Horners since it is intermittent and painful (Horners is typically not painful). What could be causing this? We are so stumped. She has also been having chronic GI issues since May 2020 that we have not been able to treat/diagnose. Seems to be extremely lethargic all the time as well. Thank you so much in advance for your help!

Hello!  Horner's is a specific syndrome, ie a group of clinical signs occuring together.  They are ptosis (where the upper eyelid droops), miosis (the pupil is small) and endopthalmus (the eyeball appears to sink into the head).  There is often a certain redness of the conjunctiva (the packing around the eyeball) involved.    A vet or a specialist ought to be able to recognise it but obviously there is something different about this case, as there are many more symptoms.  In general, vets send complicated cases to a specialist because the specialist is the expert and the vet will then accept the specialist's opinion.  So if the eye specialist says that it isn't Horner's, they must have given some indication as to what they thought it might be or what your vet should do next?   If you are not clear on this we would recommend calling them and asking what you should be doing in what timescale, or for a copy of the clinical notes, to be forwarded to yourselves and the vets. That's a huge difference in occular pressure for example - how did they account for it?  What did they want to do now? Best of luck getting the answers you seek.