Marcus Gunn jaw-winking ptosis or jaw wink ptosis is a type of condition when the upper eyelid droops over the eye and is associated with synkinetic movements of the upper eyelid moving while the jaw is chewing. Synkinesis is a neurological symptom in which a voluntary muscle movement causes a simultaneous involuntary contraction of other muscles. In jaw wink ptosis, muscle movement while chewing causes involuntary movement of the eye muscle.
Marcus Gunn jaw-winking ptosis is a congenital disorder (present at birth). It is usually seen only on one side but rarely seen on both. The condition affects men and women equally.
What causes jaw wink ptosis?
There are several theories concerning why jaw wink ptosis occurs, but the most preferred theory, which is believed by most, is that it’s a result of abnormal nerve innervation (nerve supply) between the motor branches of two nerves. One is the facial nerve, called the trigeminal nerve, that controls the muscles of chewing (mastication) and the other is the superior branch of the oculomotor nerve that controls the muscle of the eye (levator palpebrae superioris).
Since Marcus Gunn jaw-winking ptosis is a congenital disorder, it is rarely acquired later in life. However, it may develop after eye surgery, syphilis, trauma and pontine tumors (brain tumors). In cases of acquired jaw wink ptosis, spontaneous remission may occur, whereas the congenital form continues to persist without any improvement.
What are the signs and symptoms of jaw wink ptosis?
Typically, the condition is first observed by the mother while breastfeeding or bottle-feeding her baby, which is often seen as an elevation of the affected eyelid when the child feeds.
The characteristics signs of jaw wink ptosis include:
- Blepharoptosis: (when the upper eyelid droops over the eye), usually on one side and rarely on both.
- Upper eyelid movement: seen on the following,
- Mouth opening
- Movement of the jaw toward the opposite side
- Protrusion of the jaw
- Clenching jaw/teeth
Furthermore, other signs and symptoms of jaw wink ptosis can include:
- Ocular (eye):
- Strabismus (squint or crossed eye) may be seen in 50 to 60 percent of cases
- Anisometropia (when the eyes have varying refractive power)
- Amblyopia (lazy eye)
- Cleft lip/Cleft palate
- CHARGE syndrome (coloboma, heart defects, choanal atresia, growth retardation, genital and ear abnormalities)
- Renal calculi (kidney stones)
How is jaw wink ptosis diagnosed?
A doctor can make a clinical diagnosis of the condition based on the mother’s history and by observing the signs and symptoms.
Additionally, other diagnostic tests may be performed, such as:
- Measuring the extent of jaw wink ptosis: the amount of jaw-winking is measured with a millimeter ruler and categorized into
- Mild < 2 mm
- Moderate 2 to 5 mm
- Severe ≥ 6 mm
- Testing for abnormal oculocardiac (eye-heart) reflex: this reflex may be associated with the condition and doctors test it by performing an electrocardiogram (EKG or ECG) prior to surgery.
How is jaw wink ptosis managed?
Though spontaneous remission of acquired jaw wink ptosis is possible, the congenital form continues to persist without any improvement. Hence, it requires treatment options, such as:
- Conservative treatment: If amblyopia (vision loss in one eye) is present, doctors may treat it aggressively with occlusion therapy and/or correction of anisometropia (unequal refractive power in both eyes) before any ptosis surgery. Doctors would advise regular follow-up.
- Surgery: There are several surgical procedures to correct jaw wink ptosis, such as removal of part of the levator muscle of the eye without extensive dissection and damage to eye/eyelid structures, sling procedures, etc. The surgeon would recommend an appropriate technique based on the extent of the jaw wink ptosis.
Complications of surgery
Prognosis is usually good in the majority of cases. However, complications can occur even two to four weeks after surgery, and may result in the following:
- Undercorrection or overcorrection
- Lagophthalmos (incomplete or defective closure of the eyelids)
- Suture granuloma (non-cancerous, inflammatory mass at the site of sutures/stitches)
- Sling slippage in sling procedures
- Asymmetric eyelid crease causing cosmetic concerns
- Inflammation and infection
- Amblyopia (lazy eye) can occur in 30 to 60 percent of cases; however, with observation and treatment, it can be treated successfully.
Health Solutions From Our Sponsors
Top What Is Jaw Wink Ptosis Related Articles
Are Lazy Eyes Genetic?From a child’s birth until their 18th birthday, the brain and eyes form crucial connections. Genetics can play a role in causing lazy eyes. In case of a family history of amblyopia (lazy eye), it is better to consult an eye doctor at two years of age. Lazy eyes mainly occur in children and should be treated early.
Eye Health: 11 Tips for Healthy EyesightSharp eyesight is part of good health. Improve vision by eating well and scheduling regular eye exams with your ophthalmologist or optometrist. Certain medical conditions, like diabetes and high blood pressure, can negatively affect vision.
Watery EyesAlways tearing up? Everyday things can make your eyes water, but so can some medical conditions.
Eye Health: Worst Foods for Your EyesWhat you eat can play a major role in the health of your eyes. Find out which foods to cut down on and some that will help keep your outlook healthy.
Eye Conditions QuizWhat do you know about your eyes? Take this quick quiz to learn about a range of eye diseases and conditions.
How Do You Get Rid of Puffiness Under the Eyes?Bags and shadows under your eyes are a common occurrence. They make you look dull and haggard. The treatment strategy often depends on its cause, and the care may vary with every individual.
How Do You Remove Dark Circles Under Eyes Permanently?Dark circles are puffiness and darkening of the skin under the eye, and they create cosmetic concerns. Dark circles appear in men and women. They are more common in adults and rarely seen in children. The skin under the eye is normally thinner and sensitive than the rest of the face. So, it is prone to hyperpigmentation and swelling. Dark circles are usually caused because of a combination of multiple factors.
How Do You Treat Dry Eyes?Treatment for dry eye syndrome can include a range of home remedies and over-the-counter eye drops. For more severe cases, oral medication or surgery may be required.
How Does an Optometrist Check Your Eyes?Changes in the health of the eyes happen gradually without any obvious signs of disease. Eye test helps detect eye problems at an early stage; hence, treatment can be started immediately to reduce the risk of any permanent damage to the eyes. An eye test or examination done by an optometrist or ophthalmologist involves a comprehensive series of tests to evaluate the visual abilities and health of the eyes.
How Does Graves’ Disease Affect Your Eyes?What is Graves' disease, and how does it affect your eyes? Learn the signs of thyroid eye disease, what causes it, and how it is treated.
Strabismus (Crossed Eyes) PictureStrabismus, also known as crossed eyes, is a condition in which the eyes don't look toward an object together. See a picture of Strabismus and learn more about the health topic.
What Causes Yellow Discharge From Eyes?What is yellow discharge from your eye? Learn what causes it, how to recognize it, and how it is treated.
Why Are My Eyes Twitching?Eye twitching, or blepharospasm, is a condition in which you cannot keep your eyes open for a long time due to spasms. The main causes of eye twitch include fatigue, stress, smoking, caffeine, medication side effects, light sensitivity, lack of sleep, foreign particles in the eye, and corneal irritation.
Why Is Blue Light Bad for the Eyes?Blue light is part of the visible light spectrum with the shortest wavelength and highest energy. It can pass straight to the retina of the eyes through the passage to the cornea and lens.