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Rym Maamouri, Molka Ferchichi, Yasmine Houmane, Zaineb Gharbi, Monia Cheour Department of Ophthalmology, Habib Thameur Hospital, Tunis, TunisiaCorrespondence: Rym Maamouri, Department of Ophthalmology, Habib Thameur Hospital, 3, Rue Ali Ben Ayed, Montfleury, Tunis, 1089, Tunisia, Tel +21698314970, Email ryma.maamouri@fmt.utm.tnAbstract: Horner’s syndrome (HS) is caused by a damage to the oculosympathetic pathway. HS may be congenital, but it is usually acquired and may reveal a life-threatening condition. According to the anatomic location of the underlying pathologic process, HS is classified as central, pre- or postganglionic, when the lesion affects the first, second or third-order neuron, respectively. Pharmacological testing, if available, can be used to differentiate HS from « pseudo-HS » in patients with mild symptoms. Given the financial burden that imaging of the entire oculosympathetic pathway represents, a targeted imaging approach is advised. Although in the majority of cases, clinical examination may predict etiology, in other cases pharmacological testing can help in the localization process. We searched PubMed data base for papers published before December 2022 that concerned Horner’s syndrome, its neuro-ophthalmological manifestations and diagnosis. In this article, we describe the main neuro-ophthalmological manifestations of the three types of HS, the most common etiologies, and a targeted diagnostic strategy in each type.Keywords: Horner’s syndrome, neuro-ophthalmology, pharmacological testing