J Korean Ophthalmol Soc.  2009 Feb;50(2):299-302. 10.3341/jkos.2009.50.2.299.

A Case of Bilateral Marcus-Gunn Syndrome

• Choi SW
• Yang JW
• Lee SG

• KMID: 2212067
• DOI: http://doi.org/10.3341/jkos.2009.50.2.299

Abstract

PURPOSE: To report a case of bilateral Marcus Gunn syndrome, which can be easily overlooked.
CASE SUMMARY
A 6-year-old boy visited our clinic complaining of right ptosis. On ocular examination, the palpebral fissure width was 4 mm in the right lid and 7 mm in the left lid. Marginal reflex distance 1 (MRD 1) was -1 mm in the right lid and 2 mm in the left lid. Bilateral levator muscle function was good. When the patient moved the jaw to the right side, the left eyelid was retracted by 2 mm, and when the jaw was moved to the left side, the right upper eyelid retracted by 4 mm, which showed a moderate bilateral jaw-winking phenomenon. There was no change in bilateral palpebral fissure width when only opening the mouth without jaw movement.
CONCLUSIONS
Asymmetrical bilateral ptosis can be easily misdiagnosed for unilateral ptosis, and concurrent Marcus Gunn phenomenon can exist. Therefore, a thorough examination is necessary when examining a ptosis patient.

Keyword

Bilateral marcus gunn syndrome; Jaw-winking phenomenon; Ptosis

MeSH Terms

Blepharoptosis
Child
Eyelids
Heart Defects, Congenital
Humans
Jaw
Jaw Abnormalities
Mouth
Muscles
Nervous System Diseases
Reflex
Reflex, Abnormal
Blepharoptosis
Heart Defects, Congenital
Jaw Abnormalities
Nervous System Diseases
Reflex, Abnormal

Figure

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  Figure 1. Bilateral unequal ptosis in the primary position. Palpebral fissure width was 4 mm in the right lid, 7 mm in the left lid.

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  Figure 2. The left eyelid was retracted by 2 mm, when the patient moves the jaw to the right side.

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  Figure 3. The right upper eyelid retracted by 4 mm, when patient moves the jaw to the left side.

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  Figure 4. No change of bilateral palpebral fissure width when just opening the mouth without jaw movement.

Reference

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