Treatment of the Jaw-Winking Syndrome

BACKGROUND: Marcus Gunn described for the first time a syndrome consisting of unilateral, congenital ptosis, and rapid exaggerated elevation of the ptotic eyelid during movement of the mandible to the contralateral side. METHODS: Here, clinical findings from the management of 20 patients with jaw-winking syndrome have been reviewed. Preoperative measurement of the ptotic degree and the levator function by Berke's method, and marginal limbal distance were all evaluated. Moreover, the amount of winking found in the upper eyelid on primary gaze was graded on a scale from I to III. The operation was performed on 20 patients under local anesthesia: 10 by unilateral levator resection and the other 10 by the frontalis muscle falp or orbicularis oculi muscle flap. RESULTS: The correction of blepharoptosis was possible without encountering severe complications. However, a moderated degree of jaw-winking, slight undercorrection, and transient lagophthalmos were all inevitable. CONCLUSIONS: The management of patients with jaw-winking syndrome is a challenging endeavor. Therefore, a comprehensive medical and ophthalmologic evaluation and a detailed history are mandatory before undertaking the successful treatment of patients with this syndrome.