Incidence and clinical profile of Marcus Gunn jaw-winking phenomenon in congenital ptosis at a tertiary eye hospital in western Uttar Pradesh, India

Abstract

The objectives of this study were to report the hospital-based incidence and a rare case series of Marcus Gunn jaw-winking phenomenon (MGJWP) in patients with congenital ptosis This was a retrospective non-interventional case series. The medical records of all patients diagnosed with MGJWP over the past 3.5 years were retrieved from the electronic medical record. Patients with documented evidence of the presence of ptosis with MGJWP were included and analyzed for visual acuity, the presence of squint and amblyopia, and the presence of other aberrant regenerations. A total of 198 patients were diagnosed with congenital ptosis, out of which 23 (11.6%) patients had MGJWP along with congenital ptosis and 175 (84.4%) patients have congenital ptosis without MGJWP. There were 12 males and 11 females. The mean age at presentation was 10.35 ± 8.4 years (range from 2 to 28 years). All the patients presented unilateral MGJWP. The right eye was involved in seven patients (30.4%) and the left eye in 16 patients (69.5%). Most of the patients had observed the onset of MGJWP by parents since birth. Visual acuity was measured by Snellen’s distance acuity chart in 15 patients. Eight patients were preverbal, and their vision was assessed by the fixation pattern, which was central, steady, and maintained. Nine patients (39.1%) were emmetropic, seven patients (30.4%) had astigmatism, and seven patients were amblyopic in the affected eye. Strabismus was noted in nine patients (39.1%) in this study. Monocular elevation deficiency was noted in five patients, three patients have exotropia, and one had hypotropia. All the patients had a mild form of MGJWP with no intervention required in any of the cases. The hospital-based incidence of MGJWP in congenital ptosis is 11.6%. Most of the patients had observed the onset of MGJWP by their parents since birth.