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Case Reports
. 2025 Jul 16;17(7):e88119.
doi: 10.7759/cureus.88119. eCollection 2025 Jul.

Report of a Rare Case and Literature Review of Combined Marcus Gunn Jaw Winking Synkinesis and Monocular Elevation Deficiency

Omar Moussa Pasha  1 , Rocio Bentivegna  1 , Gabriela Espinoza  1
Affiliations
Case Reports

Report of a Rare Case and Literature Review of Combined Marcus Gunn Jaw Winking Synkinesis and Monocular Elevation Deficiency

Omar Moussa Pasha et al. Cureus. .

Abstract

Marcus Gunn Jaw Winking Synkinesis (MGJWS) is a rare congenital condition characterized by unilateral ptosis that improves with ipsilateral jaw movement. It frequently presents alongside other ocular abnormalities, including strabismus and anisometropia, which significantly increase the risk of amblyopia. Monocular elevation deficiency (MED), a type of strabismus marked by impaired elevation of the eye in all gaze positions, is most commonly associated with MGJWS. We report the case of a 14-year-old male with a history of refractive amblyopia who presented with both MGJWS and MED. This case supports emerging evidence that MGJWS and MED may represent phenotypic variations of the same neurodevelopmental disorder, with the severity of ptosis possibly potentiating the co-occurrence of MED. It also underscores the importance of early and comprehensive ophthalmologic evaluation in patients with MGJWS for the detection of coexisting ocular abnormalities that increase the risk of amblyopia.

Keywords: amblyopia; double levator palsy; marcus-gunn jaw winking synkinesis; monocular elevation deficiency; strabismus.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative evaluation of MGJWS
Image A was taken at rest. Image B was taken during active jaw movement. MGJWS: Marcus-Gunn jaw winking synkinesis
Figure 2
Figure 2. Preoperative evaluation of MED in primary gaze
MED: Monocular elevation deficiency
See this image and copyright information in PMC

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