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Jaw-winking marcus gunn management in Ophthalmology Department Sanglah Hospital Denpasar

Etika Widhiastuti , AAA Sukartini Djelantik, Putu Yuliawati

Etika Widhiastuti
Ophthalmology Department, Faculty of Medicine Udayana University, Sanglah Hospital Denpasar. Email: etika21@gmail.com

AAA Sukartini Djelantik
Ophthalmology Department, Faculty of Medicine Udayana University, Sanglah Hospital Denpasar

Putu Yuliawati
Ophthalmology Department, Faculty of Medicine Udayana University, Sanglah Hospital Denpasar
Online First: November 02, 2017 | Cite this Article
Widhiastuti, E., Djelantik, A., Yuliawati, P. 2017. Jaw-winking marcus gunn management in Ophthalmology Department Sanglah Hospital Denpasar. Bali Journal of Ophthalmology 1(1): 8-13. DOI:10.15562/bjo.v1i1.3


Introduction: Jaw-Winking Marcus Gunn was first introduced in 1883 as unilateral ptosis with eyelid retraction due to activation of pterygoid muscle (jaw movement). Marcus Gunn jaw-winking usually appear from birth. Some of the techniques proposed to eliminate the levator function, which levator function can effectively reduce the movemnet of the eyelid. This report aims to describe the case of Jaw-Winking Marcus Gunn treated with levator resection procedures and frontal suspension.

Case Description: A woman 23 years old came to Sanglah Hospital complaining the left eyelid moves up and down with movement of the mouth, especially when eating and talking. Right eye visual acuity 6/6, left eye 6/30 pinhole 6/20 C-1.00 Ax 180 6/12, ortophoria in primary position. Vertical fissure 5 mm, margin reflex distance -1 mm when the mouth is closed and +5 mm when the mouth is opened, levator action 4 mm, margin limbal distance 3 mm. Funduscopic examination of the posterior segment of both eyes in this patient was normal. Patient was diagnosed as Marcus Gunn jaw-winking ptosis and planned for  management with myectomy and fascia lata frontal sling. Ten months after surgery, eyelid movement when chewing is still visible. The results of  the examination showed right eye visual acuity is 6/6 and left eye 6/30 pinhole 6/12 with a correction of the C-1.00 Ax 180 is 6/12. Vertical fissure 9 mm, margin reflex dstance +2 mm when the mouth is closed and +3 mm when the mouth is opened, levator action 0.

Discussion: Levator resection technique and frontal suspension procedures can results in resolution of Jaw-Winking Marcus Gunn.

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