Medscape is available in 5 Language Editions – Choose your Edition here.


Marcus Gunn Jaw-winking Syndrome Follow-up

  • Author: Barbara L Roque, MD, DPBO, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Apr 06, 2016

Further Outpatient Care

While the patient is awake, apply cold compresses to the eyelids for 20 minutes every 1-2 hours for 2-3 days to decrease swelling and bruising.

See the patient postoperatively in 5-7 days for suture removal.

Schedule regular follow-up appointments with a general or pediatric ophthalmologist for any child with preexisting amblyopia.


Further Inpatient Care

Marcus Gunn jaw-winking ptosis usually is treated on an outpatient basis.


Inpatient & Outpatient Medications

Antibiotic ophthalmic ointment, such as erythromycin, is prescribed postoperatively, and it should be applied 2-4 times a day along sutures and in the eye for 1 week.



Complications of surgery to repair jaw-winking ptosis include the following:

  • Unacceptable eyelid height or contour
  • Exaggerated postoperative wink
  • Asymmetry
  • Poor wound healing
  • Wound infection
  • Bleeding or hematoma formation
  • Inflammation and granuloma formation around frontalis sling material


Satisfactory results are usually achieved by a medical and surgical approach to managing Marcus Gunn jaw-winking ptosis.


Patient Education

Discuss the following with the patient or the parents:

  • Connection between jaw movement and abnormal movement of the eyelid
  • Importance of treating amblyopia or strabismus prior to any surgical repair of ptosis
  • Various surgical approaches, to include possible benefits of bilateral eyelid surgery
Contributor Information and Disclosures

Barbara L Roque, MD, DPBO, FPAO Senior Partner, Roque Eye Clinic; Chief of Service, Pediatric Ophthalmology and Strabismus Section, Department of Ophthalmology, Asian Hospital and Medical Center; Active Consultant Staff, International Eye Institute, St Luke's Medical Center Global City

Barbara L Roque, MD, DPBO, FPAO is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Cataract and Refractive Surgery, Philippine Society of Cataract and Refractive Surgery, Philippine Academy of Ophthalmology, Philippine Society of Pediatric Ophthalmolo

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Michael J Bartiss, OD, MD Medical Director, Ophthalmology, Family Eye Care of the Carolinas and Surgery Center of Pinehurst

Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, North Carolina Medical Society, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Sean M Blaydon, MD, FACS Fellowship Program Director, Texas Oculoplastic Consultants

Sean M Blaydon, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, International College of Surgeons US Section, Pan-Pacific Surgical Association, Texas Medical Association

Disclosure: Nothing to disclose.

  1. Gunn RM. Congenital ptosis with peculiar associated movements of the affected lid. Trans Ophthal Soc UK. 1883. 3:283-7.

  2. Sobel RK, Allen RC. Incidence of bilateral Marcus Gunn jaw-wink. Ophthal Plast Reconstr Surg. 2014 May-Jun. 30 (3):e54-5. [Medline].

  3. Kannaditharayil D, Geyer H, Hasson H, Herskovitz S. Bilateral Marcus Gunn jaw-winking syndrome. Neurology. 2015 Mar 10. 84 (10):1061. [Medline].

  4. Pratt SG, Beyer CK, Johnson CC. The Marcus Gunn phenomenon. A review of 71 cases. Ophthalmology. 1984 Jan. 91(1):27-30. [Medline].

  5. Bradley WG, Toone KB. Synkinetic movements of the eyelid: a case with some unusual mechanisms of paradoxical lid retraction. J Neurol Neurosurg Psychiatry. 1967 Dec. 30(6):578-9. [Medline].

  6. Kirkham TH. Paradoxical elevation of eyelid on smiling. Am J Ophthalmol. 1971 Jul 30. 72(1):207-8. [Medline].

  7. Parry R. An unusual case of the Marcus Gunn syndrome. Trans Opthal Soc U K. 1957. 77:181-5. [Medline].

  8. Kirkham TH. Familial Marcus Gunn phenomenon. Br J Ophthalmol. 1969 Apr. 53(4):282-3. [Medline].

  9. Beard C. Ptosis. 3rd ed. St. Louis: CV Mosby; 1981. 46-9.

  10. Duke Elder S. Normal and abnormal development; congenital deformities. System of Ophthalmology. St. Louis: CV Mosby; 1963. Vol 3, pt 2: 900-5.

  11. Pandey M, Baduni N, Jain A, Sanwal MK, Vajifdar H. Abnormal oculocardiac reflex in two patients with Marcus Gunn syndrome. J Anaesthesiol Clin Pharmacol. 2011 Jul. 27(3):398-9. [Medline]. [Full Text].

  12. Conte A, Brancati F, Garaci F, Toschi N, Bologna M, Fabbrini G, et al. Kinematic and diffusion tensor imaging definition of familial Marcus Gunn jaw-winking synkinesis. PLoS One. 2012. 7(12):e51749. [Medline]. [Full Text].

  13. Hepler RS, Hoyt WF, Loeffler JD. Paradoxical synkinetic levator inhibition and excitation. An electromyographic study of unilateral oculopalpebral and bilateral mandibulopalpebral (Marcus Gunn) synkineses in a 74-year-old man. Arch Neurol. 1968 Apr. 18(4):416-24. [Medline].

  14. Wartenberg R. Winking-jaw phenomenon. Arch Neurol Psychiatry. 1948 Jun. 59(6):734-53. [Medline].

  15. Lyness RW, Collin JR, Alexander RA, et al. Histological appearances of the levator palpebrae superioris muscle in the Marcus Gunn phenomenon. Br J Ophthalmol. 1988 Feb. 72(2):104-9. [Medline].

  16. Kaçar Bayram A, Per H, Quon J, Canpolat M, Ülgen E, Doğan H, et al. A rare case of congenital fibrosis of extraocular muscle type 1A due to KIF21A mutation with Marcus Gunn jaw-winking phenomenon. Eur J Paediatr Neurol. 2015 Nov. 19 (6):743-6. [Medline].

  17. Khwarg SI, Tarbet KJ, Dortzbach RK, et al. Management of moderate-to-severe Marcus-Gunn jaw-winking ptosis. Ophthalmology. 1999 Jun. 106(6):1191-6. [Medline].

  18. Doucet TW, Crawford JS. The quantification, natural course, and surgical results in 57 eyes with Marcus Gunn (jaw-winking) syndrome. Am J Ophthalmol. 1981 Nov. 92(5):702-7. [Medline].

  19. Bowyer JD, Sullivan TJ. Management of Marcus Gunn jaw winking synkinesis. Ophthal Plast Reconstr Surg. 2004 Mar. 20(2):92-8. [Medline].

  20. Wong JF, Theriault JF, Bouzouaya C, et al. Marcus Gunn jaw-winking phenomenon: a new supplemental test in the preoperative evaluation. Ophthal Plast Reconstr Surg. 2001 Nov. 17(6):412-8. [Medline].

  21. Bajaj MS, Angmo D, Pushker N, Hada M. Modified technique of levator plication for the correction of Marcus Gunn jaw-winking ptosis: a case series. Int Ophthalmol. 2015 Aug. 35 (4):587-91. [Medline].

  22. Putterman AM. Jaw-winking blepharoptosis treated by the Fasanella-Servat procedure. Am J Ophthalmol. 1973 Jun. 75(6):1016-22. [Medline].

  23. Bullock JD. Marcus-Gunn jaw-winking ptosis: classification and surgical management. J Pediatr Ophthalmol Strabismus. Nov-Dec 1980. 17(6):375-9. [Medline].

  24. Epstein GA, Putterman AM. Super-maximum levator resection for severe unilateral congenital blepharoptosis. Ophthalmic Surg. 1984 Dec. 15(12):971-9. [Medline].

  25. Dillman DB, Anderson RL. Levator myectomy in synkinetic ptosis. Arch Ophthalmol. 1984 Mar. 102(3):422-3. [Medline].

  26. Dryden RM, Fleming JC, Quickert MH. Levator transposition and frontalis sling procedure in severe unilateral ptosis and the paradoxically innervated levator. Arch Ophthalmol. 1982 Mar. 100(3):462-4. [Medline].

  27. Kersten RC, Bernardini FP, Khouri L, et al. Unilateral frontalis sling for the surgical correction of unilateral poor-function ptosis. Ophthal Plast Reconstr Surg. 2005 Nov. 21(6):412-6; discussion 416-7. [Medline].

  28. Islam ZU, Rehman HU, Khan MD. Frontalis muscle flap advancement for jaw-winking ptosis. Ophthal Plast Reconstr Surg. 2002 Sep. 18(5):365-9. [Medline].

  29. Lemagne JM. Transposition of the levator muscle and its reinnervation. Eye. 1988. 2 (Pt 2):189-92. [Medline].

  30. Neuhaus RW. Eyelid suspension with a transposed levator palpebrae superioris muscle. Am J Ophthalmol. 1985 Aug 15. 100(2):308-11. [Medline].

  31. Tian N, Zheng YX, Zhou SY, Liu JL, Huang DP, Zhao HY. Clinical characteristics of moderate and severe Marcus-Gunn jaw-winking synkinesis and its surgical treatment. Zhonghua Yan Ke Za Zhi. 2007 Dec. 43(12):1069-72. [Medline].

  32. Gupta M, Gupta OP, Vohra V. Bilateral familial vertical Duane Syndrome with synergistic convergence, aberrant trigeminal innervation, and facial hypoplasia. Oman J Ophthalmol. 2014 Sep. 7 (3):135-7. [Medline].

  33. Sundareswaran S, Nipun CA, Kumar V. Jaw - winking phenomenon: Report of a case with review of literature. Indian J Dent Res. 2015 May-Jun. 26 (3):320-3. [Medline].

Congenital left upper eyelid ptosis.
Marcus Gunn jaw-winking with left upper eyelid retraction on opening of the mouth.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.