Jaw-Winking Marcus Gunn Management in Ophthalmology Department Sanglah Hospital Denpasar

Abstract

Introduction: Jaw-Winking Marcus Gunn was first introduced in 1883 as unilateral ptosis with eyelid retraction due to activation of pterygoid muscle (jaw movement). Marcus Gunn jaw-winking usually appear from birth. Some of the techniques proposed to eliminate the levator function, which levator function can effectively reduce the movement of the eyelid. This report aims to describe the case of Jaw-Winking Marcus Gunn treated with levator resection procedures and frontal suspension.

Case Description: A woman 23 years old came to Sanglah Hospital complaining the left eyelid moves up and down with the movement of the mouth, especially when eating and talking. Right eye visual acuity 6/6, left eye 6/30 pinhole 6/20 C-1.00 Ax 180 6/12, orthophoria in primary position. Vertical fissure 5 mm, margin reflex distance -1 mm when the mouth is closed and +5 mm when the mouth is opened, levator action 4 mm, margin limbal distance 3 mm. Funduscopic examination of the posterior segment of both eyes in this patient was normal. The Patient was diagnosed as Marcus Gunn jaw-winking ptosis and planned for management with myectomy and fascia lata frontal sling. Ten months after surgery, eyelid movement when chewing is still visible. The results of the examination showed right eye visual acuity is 6/6 and left eye 6/30 pinhole 6/12 with a correction of the C-1.00 Ax 180 is 6/12. Vertical fissure 9 mm, margin reflex distance +2 mm when the mouth is closed and +3 mm when the mouth is opened, levator action 0. Discussion: Levator resection technique and frontal suspension procedures can result in resolution of Jaw-Winking Marcus Gunn.