The syndrome in which sympathetic supply to face is effected causing: ptosis (unilateral), miosis (unilateral constricted pupil), anhydrosis (unilateral loss of ability to sweat), and unaffected light and accommodation reflex the syndrome can present differently due to the different site of impairment of sympathetic system. It could be at central level (in brain) or peripheral level (involves second and third order neurons).The causes of the conditions include: demyelination injury (multiple sclerosis) tumors. Infarcts, hemorrhages, syringomyelia, Arnold- chiari malformation, pan coast tumor, apical TB, cervical rib, trauma to brachial plexus, iatrogenic, birth trauma and a Herpes zoster infection. Management options include: surgical removal or radiation therapy according to the cause.