#Marcus gunn pupil full
#Marcus gunn pupil trial

A further follow-up visit was organized at the age of 8 months to assess the need and timing of corrective surgery. Physical growth and development were otherwise normal. 7 2.2 Outcome and follow-upĪt the 4-month follow-up ophthalmic visit, no substantial improvements in the left-eye ptosis were detected. 4, 6 Lastly, Duane's syndrome, also known as Duane retraction syndrome, was not suspected because this ocular disorder is characterized by retraction movements and palpebral fissure narrowing when adduction is attempted, sometimes associated with downshoot and upshoot, and varying degrees of horizontal duction deficiency. 4 Similarly, Marin-Amat syndrome, an acquired type of oculofacial synkinesis, was excluded as this rare condition is characterized by involuntary and fleeting eye closure when the mouth opens ( eg, while the individual is smiling), due to an anomalous connection between the trigeminal and facial nerves. Indeed, in this rare congenital disorder, mouth opening (eg, while the individual is eating) induces or worsens eyelid drooping, due to an anomalous connection between the oculomotor and trigeminal nerves. Conversely, the inverse Marcus Gunn phenomenon was excluded. Based on these peculiar features, Marcus Gunn jaw-winking syndrome was diagnosed. In the present case, at the follow-up ophthalmic visit the detection of abnormal left eyelid cooperation with uncoordinated opening/closing movements was noted, together with paradoxical synkinesis in swallowing during bottle-feeding (Videos S1 and S2). 4 Congenital ptosis due to anomalies of innervation may be the result of: (a) neurologic dysfunctions (b) neuromuscular junction failure of the levator muscle or (c) dysfunction of the sympathetic nervous system (eg, Horner syndrome). The first group comprises several disorders, such as Marcus Gunn jaw-winking syndrome, inverse Marcus Gunn phenomenon, and Duane's syndrome. Instead, the suspect of congenital ptosis was confirmed.ĭifferential diagnosis of congenital ptosis included (a) anomalies of extraocular muscle development and (b) anomalies of innervation. Since the baby was delivered by an uneventful Cesarean section, a traumatic nature of the left-eye ptosis was excluded. Left-sided ptosis with the newborn hardly able to lift his left eyelid, whose opening was below the upper eyelid margin 2.1 Differential diagnosis, investigations, and treatmentĪt the 15-day follow-up ophthalmic visit, no improvements of the left-eye ptosis were detected. The newborn was discharged at 4 days of life in good clinical conditions, with a follow-up program of the ptosis. At 3 days of life, a first ophthalmologist evaluation was performed, and possible congenital ptosis was suspected. No nervous system anomalies were detected. Newborn's general appearance and clinical conditions were otherwise normal. Pupils were bilaterally isochoric, isocyclic, and reactive to light. Namely, the newborn was hardly able to lift his left eyelid, whose opening was below the upper eyelid margin (Figure 1).

#Marcus gunn pupil full

Pregnancy was unremarkable.Īt the initial full clinical examination performed soon after birth, left-eye ptosis was observed without evidence of edema. Family history was negative for congenital malformations and disorders. The boy was the first-offspring of unrelated healthy parents. Birth anthropometry taken was as follows: weight 3560 gr (75th percentile), length 51 cm (75th percentile), and head circumference 33 cm (10th percentile). At delivery, the Apgar score was 8 at 1 minute and 10 at 5 minutes of life.

#Marcus gunn pupil trial

This male newborn was delivered at 39 weeks' gestational age by Cesarean section due to a failed trial of labor. Here, we report the case of a male newborn with Marcus Gunn jaw-winking syndrome involving the left eye, which was diagnosed at 2 weeks of age. 1 It has been observed in 2%-13% of patients with congenital ptosis, with equal prevalence in males and females.

1, 3 This syndrome is likely to occur from an abnormal branch of the trigeminal nerve that, for congenital misdirection, supplies the levator palpebrae superioris muscle of the oculomotor nerve. 1, 2 Elevation and even retraction of the affected eyelid can be triggered by several mouth movements, such as chewing, suction, protruding tongue, or smiling. Marcus Gunn jaw-winking syndrome is a type of neurogenic congenital ptosis that includes an associated winking motion of the affected eyelid each time the jaw moves. These clinical findings have allowed diagnosing Marcus Gunn jaw-winking syndrome. Namely, abnormal left eyelid cooperation and uncoordinated opening/closing movements with paradoxical synkinesis in swallowing were noted. At the 15-day follow-up ophthalmic visit, no improvements were observed. Left-eye ptosis was observed in a newborn soon after birth.