|Year : 1966 | Volume
| Issue : 5 | Page : 223-224
Marcus gunn phenomenon
L. F. Hospital, Angamali, Kerala, India
|Date of Web Publication||17-Jan-2008|
S P Shukla
L. F. Hospital, Angamali, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shukla S P. Marcus gunn phenomenon. Indian J Ophthalmol 1966;14:223-4
In 1863 Marcus - Gunn described 'Jaw-Winking' in left eye of a 15 year old girl along with smaller pupil and slight weakness of orbicularis oculi on the left side. Ever since then it has remained a clinical curiosity. In 1895, Sinclair reviewed 33 cases and since then at least 100 cases have been published. Cooper (1937); Spaeth (1947a); Wartenberg (1918); and Simpson (1956) have also made detailed studies of this condition. Falls et al (1959) published a review of 115 cases. Dhir and Agarwal (1961) reported a case following ptosis surgery. Last reported case was by Mathew Roy (1966). The rarity of this condition warrants the report of a further case.
| Case Report|| |
A girl aged 18 years attended the Eye Out-Patient's Department of this Hospital on 20th May 1966 with the complaints of inability to lift the right upper lid voluntarily. She also told that during talking or eating the right upper lid moves up and down without her knowledge.
On examination it was noted that there was complete ptosis of the right eye, [Figure - 1], but on opening the mouth or movement of the lower jaw towards the left side, produced spontaneous elevation of the ptosed right lid, [Figure - 2]. Slight weakness of right superior rectus was also noted which could not be brought into action by movement of the jaw. Pupils were normal in both eyes and reacting well to light. No other neurological or congenital abnormality in the patient or in the family was noted.
| Discussion|| |
Marcus-Gunn Phenomenon is a rare condition characterised by associated movement consisting of elevation of ptosed eye-lid in association with opening of the mouth or side to side movement of the jaw. Ptosis is complete and congenital in over 90 per cent of reported cases. It may arise spontaneously in older persons. In 7 per cent of the patients the syndrome was without ptosis, whereas in 3 per cent it was bilateral. In some the syndrome may be produced by movement of the lips; whistling: clenching of the teeth; puffing out of the cheeks; protusion of tongue or swallowing. The syndrome has also been triggered by closing the other eye. It may also be associated with other anomalies, like ectrodactyly, bilateral pes-cavus with ankle varus and fore foot adduction, cryptorchism and replication of incisor teeth.
There are various theories to explain this peculiar associated movements. They are-
1. Abnormal nervous connection which is the most favoured hypothesis, which may be cortical, sub-cortical or inter nuclear, faulty distribution in the posterior longitudinal bundle and infra-nuclear fibres--some fibres of the third nerve may arise from the fifth nucleus or some fibres of the fifth may reach levator palpebrae via the auriculo-temporal branch. Some believe that it may be due to double innervation of the levator-i.e. by the third and fifth nerves.
2. Functional interference - Duke Elder (1952) explained it on physiological basis and postulated that it may be due to (1) irritation of normally dormant connection, (2) release of inhibitions, or (3) spread of impulses by radiation.
3. Atavistic reversion- In fish there is a strong associated movement of jaw opening and eye opening, i.e. deep muscles contracting and superficial muscles relaxing. Thus a weak levator may only elevate the lid when the orbicularis is relaxed by jaw opening.
The case illustrated above resembles Marcus-Gunn's original case except that he had unequal pupil in his case. A reverse Marcus-Gunn Phenomenon has also been described in which the ptosed eyelid becomes more drooped on opening the mouth; the so-called winking-jaw syndrome (inverse Marcus-Gunn syndrome). There is also a corneo-mandibular reflex which is manifested by a brisk movement of the mandible to the contralateral side when the cornea is touched.
The condition is a clinical curiosity and does not call for any treatment., but in some cases complete tenotomy of the levator followed by fascia lata sling to the frontalis can be done.
| Summary|| |
A case of Marcus-Gunn Phenomenon is described alone, with a brief review of the literature.
| References|| |
Cooper, E. L. (1937), Arch. Ophthal. 18:196.
Dhir, B. K. and Agrawal, M. L. (1961), J. Indian M. A.-37: 235.
Duke Elder, S.: Text book of Ophthalmology 1952, Vol. 5, Kimpton. London.
Falls, H. F.; Krause, W. T. & Cotterman, C. W. (1949). Amer. J. Ophthal, 32: 53.
Idem. (1947b), Plastic Reconstr. Surg., 2: 32.
Mathew Roy, V. C. (1966), J. Indian M. A.,46: 376.
Simpson, D. G. (1956), A. M. A. Arch. Ophthal. 56: 743.
Wartenberg, R. (1948), Arch. Neurol. Psychiat. 59: 734.
[Figure - 1], [Figure - 2]