Paradoxical elevation of eyelid on smiling

Effect of external eyelid weighting on eyelid and eyebrow position in normal and ptosis patients

PURPOSE

This study aims to characterize the physiologic response of both eyelid and eyebrow position to increasing downward forces simulated by external weights.

METHODS

In this prospective observational study, both normal individuals and patients affected by ptosis were tested. External eyelid weights were placed on one upper eyelid with incrementally increasing weight from 0.2 to 2.4 g. The eyelid carrying the weight was randomly selected for normal subjects and patients with bilateral ptosis, whereas for unilateral ptosis, the ptotic eyelid was utilized. Photographs were obtained at baseline and with increasing weight until MRD1 reached 0 on the weighted side or, until 2.4 g was reached. Eyelid and brow position on the weighted and unweighted sides were digitally measured in millimeter. Primary outcome measures were change in the margin to reflex distance (MRD1) and pupil to brow distance (PTB) with weight on the weighted and unweighted sides for normal and ptosis subjects.

RESULTS

The weighted eyelid MRD1 decreased linearly with increasing weight. This was true for normal and ptosis subjects. The unweighted eyelid MRD1 increased linearly with increasing weight. This was also the case for both normal and ptosis subjects. With increasing weight, PTB increased linearly on the weighted side. No significant intergroup differences were noted.

CONCLUSIONS

In normal and ptosis subjects, when external weight on the eyelid is incrementally increased, the weighted eyelid MRD1 decreases, the unweighted eyelid MRD1 increases, and both brows elevate in a linear fashion.

Marcus Gunn (jaw-winking) phenomenon in pediatric otorhinolaryngology practice

Marcus Gunn phenomenon (MGP) is a rare form of congenital facial synkinesis known as jaw-winking or pterygoid-levator synkinesis. The MGP is the raising of the affected eyelid is synchronous and proportionate to the opening of the mouth. The etiology is unclear. Most authors claim that a branch of trigeminal nerve has been congenitally misdirected into position of the oculomotor nerve which supplies the levator muscle of the upper lid. The MGP deals with number of problems which have to be manage by ENT doctors, but they are not well‑documented. We describe the first time Marcus Gunn phenomenon associated with an olfactory nerve disturbance. We have especially emphasized laryngological aspect of MGP diagnosis and the need for deeper interdisciplinary diagnostics in each child with olfactory dysfunction.

Familial ptotic lid elevation during ipsilateral abduction

PURPOSE

To report and discuss the clinical findings of a 17-member family with 2 siblings who exhibit ptosis and abnormal synkinetic lid elevation associated with ipsilateral abduction.

SUBJECTS AND METHODS

Sixteen members of the 17-member immediate family underwent ophthalmic examination.

RESULTS

Two siblings exhibited ptosis and abnormal synkinetic lid elevation associated with ipsilateral abduction. One was bilaterally affected and the other had unilateral findings. A third sibling had isolated bilateral congenital ptosis. A fourth demonstrated classic Duane syndrome Type I in the right eye. Other family members did not have ophthalmic abnormalities.

CONCLUSIONS

A unifying mechanism of congenital cranial dysinnervation may underlie these and similar phenotypes of oculomotor and/or abducens nerve abnormalities with or without abnormal synkinesis.

A clinical sign of the Marcus Gunn phenomenon. Case Report

We present a 33-year-old man with severe unilateral congenital blepharoptosis associated with the Marcus Gunn "jaw-winking" phenomenon. The most important factor in surgical treatment was elimination of the synkinetic reflex. We also thought that excision of as much of the levator muscle as possible was necessary. The result was both functionally and cosmetically satisfactory.

Synkinesis between facial nerve and oculomotor nerve. A case report

We present a case history of a young man suffering from a facial-oculomotor synkinesis. The findings speak in favour of an acquired synkinesis due to trauma. Most probably the injury occurred in the midbrain, in the area of the vertical gaze control center and/or the area of the levator palpebrae motoneurons. A congenital synkinesis due to embryonic malformation seems to be unlikely, because at birth no restriction of the eye-ball motility was present.

The differential diagnosis and classification of eyelid retraction

BACKGROUND

Classification schemes are useful in the formulation of differential diagnoses. Thoughtful commentary has been devoted to the classification of blepharoptosis, but the causes of eyelid retraction have received less attention in published reports. Although eyelid retraction most frequently is associated with Graves ophthalmopathy, numerous other entities may cause the sign. This study was undertaken to provide a more comprehensive differential diagnosis and classification of eyelid retraction.

METHODS

A series of patients with eyelid retraction was studied, and pertinent published reports were reviewed.

RESULTS

Forty-four patients with different causes for eyelid retraction are described. Normal thyroid function and regulation were confirmed in all patients in whom Graves ophthalmopathy could not be excluded by clinical, biochemical, or historical criteria.

CONCLUSION

Based on a series of patients and reported cases, a differential diagnosis for eyelid retraction is proposed using a classification system compromising three categories (neurogenic, myogenic, and mechanistic).

The Marcus Gunn phenomenon. Discussion and report of a case

A detailed clinical description of the Marcus Gunn phenomenon is featured. Related ophthalmologic aberrations associated with mandibular movement are briefly discussed. A report of a case of Marcus Gunn phenomenon, which was significant for a paternal history of bilateral cleft lip and palate, is presented. The general and the dental considerations in the management of this disorder are summarized. Protective eye shields are recommended for use during dental procedures.

Unilateral blepharoptosis with synkinetic movements of the eyelids on horizontal gaze

A 17-year-old woman with a left congenital ptosis and an alternating esotropia is presented. During horizontal gaze to the right and left, the eyelid of the abducting eye elevated and the eyelid of the adducting eye lowered. There were no synkinetic eyelid movements with contraction of the pterygoid, sternocleidomastoid, or facial muscles. Synkinetic eyelid movements due to aberrant regeneration were unlikely due to absence of previous third nerve palsy. A supranuclear innervational abnormality is proposed to explain the clinical findings.

The Marcus Gunn phenomenon. A review of 71 cases

We have reviewed the clinical findings, natural course, pathologic observations, and management of 71 patients with the Marcus Gunn phenomenon. We found individuals with this syndrome to have a significant incidence of amblyopia (59%), double elevator palsy (25%), anisometropia (25%), and superior rectus muscle palsy (23%). Long-term follow-up did not reveal a case that improved with age. In most patients requiring surgery, we recommend a unilateral levator excision on the affected side plus a bilateral frontalis suspension.

The quantification, natural course, and surgical results in 57 eyes with Marcus Gunn (jaw-winking) syndrome

Subjective findings and objective surgical results in 55 individuals with the Marcus Gunn (jaw-winking syndrome indicated that bilateral fascial suspension is the best procedure in most cases. Levator muscle resection treats only the blepharoptosis (often undercorrecting it), may exacerbate the jaw-winking, and is associated with significant eyelid lag in many cases. In the 17 patients who had not undergone surgery, there was no significant spontaneous reduction in the degree of jaw-winking. Additionally, the patient's belief that the jaw-winking had improved with time was often inaccurate, indicating that objective measurements are necessary before conclusions can be drawn about the natural course of this phenomenon. We also found that high incidences of strabismus (36%) and amblyopia (34%) are associated with this syndrome.