Year : 1963 | Volume
: 11 | Issue : 4 | Page : 108--109
Inverse marcus gunn phenomenon
G. R. Medical College, Gwalior, India
I M Shukla
G. R. Medical College, Gwalior
|How to cite this article:|
Shukla I M. Inverse marcus gunn phenomenon.Indian J Ophthalmol 1963;11:108-109
|How to cite this URL:|
Shukla I M. Inverse marcus gunn phenomenon. Indian J Ophthalmol [serial online] 1963 [cited 2020 Feb 19 ];11:108-109
Available from: http://www.ijo.in/text.asp?1963/11/4/108/38969
During the recovery period of peripheral facial nerve palsy an interesting although rare anomaly may present itself, in which the partially posed lid further droopsy when the patient yawns or masticates. This reaction has been described as reverse jaw-winking or inverse MARCUS GUNN phenomenon (Duke Elder, 1952. Walsh, 1957).
A village shopkeeper aged 38 years was admitted in J. A. Hospital, Gwalior on 21-6-1962 for chronic congestive Glaucoma of the left eye.
He gave the history of having suffered from some trouble in his left ear about one year back as a result of which he had developed symptoms of facial paralysis on the left side. He was treated in a District Hospital but with little improvement. There was no history of trauma, nor any previous trouble in his left eye since his birth, except pain and congestion for the last one month. In his right eye there was history of some `ocular trouble' in his childhood as a result of which it was rendered blind. There was no history of any ocular defect in his family.
Examination:- The slight drooping of the right lid can be seen in [Figure 1] There was no other neurological abnormality. Examination of all the other systems were normal. 13.P. was 130/70.
Right Eye had a divergent squint with a central leucomatous corneal opacity covering the entire pupillary area. There was no light perception. The fundus could not be seen.
Left eye had a partial ptosis with normal ocular movements. Conjunctiva was congested, anterior chamber shallow and the pupil was dilated, reacting sluggishly to light. Tension (SCHIOTZ) was 38 mm. of Hg. Visual acuity was 6124. The fundus was normal. There was no cupping of the disc.
During the course of examination for facial paralysis it was noticed that the degree of ptosis markedly increased when the patient was asked to whistle or puff his cheeks [Figure 2]. Also there was increase in the ptosis when the patient was asked to open the mouth widely. [Figure 3].
Movements of lower facial muscles are usually associated with a contraction of orbicularis oculi muscle, so that during the movements of mastication or when the mouth is wide open the eye is closed or the degree of ptosis is much increased. The term inverse Marcus Gunn phenomenon although describes the actual movements involved, these reactions do not constitute a trigemino-facial association, but are due to events within the territory of the facial nerve itself. These abnormal movements are probably caused by aberrant regeneration of nerve fibers, some axons growing into the wrong sheath in the anatomical disorder which may accompany regeneration.
A case of inverse Marcus Gun phenomenon having developed during the course of recovery of a left sided facial paralysis is presented.
|1||Duke-Elder, S. (1952) "Text Book of ophthalmology". Vol. 5, p. 5172. Kimpton. London.|
|2||Walsh. F. B. (1957) "Clinical Neuro-ophthalmology". 2nd Ed. P. 203. William and Wilkins. Baltimore.|