Peer Reviewed

What's Your Diagnosis?

Ptosis and Rhythmic Eye Movement in a Young Child

Shane M. Clark, MSc1 • Mallika Bhatta, BS1 • Casey Beal, MD2 • Kathryn Wheeler, MD3 • Rachel Coleman, MD3

Volume 63 - Issue 1 - January 2023

  • AFFILIATIONS:
    1College of Medicine, University of Florida Health, Gainesville, FL
    2Department of Ophthalmology, University of Florida Health, Gainesville, FL
    3Department of Pediatrics, University of Florida Health, Gainesville, FL

    CITATION:
    Clark SM, Bhatta M, Beal C, Wheeler K, Coleman R. Ptosis and rhythmic eye movement in a young child. Consultant. 2023;63(1):15-17. doi:10.25270/con.2022.02.00012

    Received September 29, 2021. Accepted October 25, 2021. Published online May 23, 2022.

    DISCLOSURES:
    The authors report no relevant financial relationships. The authors report that informed patient consent was obtained for publication of the images used herein.

    CORRESPONDENCE:
    Rachel Coleman, MD, University of Florida Health, 1600 Southwest Archer Road, Gainesville, FL 32610 [rmcoleman@peds.ufl.edu]

    A 4-week-old boy presented to the pediatric clinic for a well-child examination. The patient was born at 37 weeks’ gestation, and his growth and development had been normal up to this point. Pediatric course had been complicated only by difficulties latching due to ankyloglossia, gastroesophageal reflux disease, and milk protein intolerance.

    During the visit, the patient’s mother reported that she noticed he was experiencing a mild drooping of his right eyelid that improved when he opened his jaw (Figure 1). She also noticed that the patient’s right upper eyelid was elevating rhythmically during feeding (Figure 2). The patient had no other abnormal eye movements or signs of eye discomfort other than while suckling, and he was able to keep his eyes completely open when alert.

     

    Figure 1. Unilateral ptosis of the patient at rest.


    Figure 1. Unilateral ptosis of the patient at rest.

    Figure 2. Wink phenomenon shown during active feeding.


    Figure 2. Wink phenomenon shown during active feeding.

     

    The patient’s mother denied any family history of ocular abnormalities. On physical examination, the patient’s head, eyes, ears, nose, and throat were normal; his cardiac, pulmonary, neurologic, and musculoskeletal examinations also were normal.

     

    Based on the patient’s background and presentation, what is your diagnosis?

    A. Bell palsy

    B. Horner syndrome

    C. Marcus Gunn syndrome

    D. Corneal abrasion

    E. Congenital fibrosis of the extraocular Muscles (CFEOM)

References

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2. Kannaditharayil D, Geyer H, Hasson H, Herskovitz S. Bilateral Marcus Gunn jaw-winking syndrome. Neurology. 2015;84(10):1061. doi:10.1212/WNL.0000000000001338

3. Sobel RK, Allen RC. Incidence of bilateral Marcus Gunn jaw-wink. Ophthalmic Plast Reconstr Surg. 2014;30(3):e54-55. doi:10.1097/IOP.0b013e31829bb405

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10. Pratt SG, Beyer CK, Johnson CC. The Marcus Gunn phenomenon: a review of 71 cases. Ophthalmology. 1984;91(1):27-30. doi:10.1016/s0161-6420(84)34331-7

11. Doucet TW, Crawford JS. The quantification, natural course, and surgical results in 57 eyes with Marcus Gunn (jaw-winking) syndrome. Am J Ophthalmol. 1981;92(5):702-707. doi:10.1016/s0002-9394(14)74665-3

12. Iliff CE. The optimum time for surgery in the Marcus Gunn phenomenon. Trans Am Acad Ophthalmol Otolaryngol. 1970;74(5):1005-1010.

13. Bair H, Garcia GA, Erickson BP. Surgical management of jaw-winking synkinesis and ptosis in Marcus Gunn syndrome: a systematic outcomes analysis. Plast Aesthet Res. 2020;7(68). doi:10.20517/2347-9264.2020.74

14. Vyas KS, Kim U, North WD, Stewart D. Frontalis sling for the treatment of congenital ptosis. Eplasty. 2016;16(ic12).