An atypical case of Marcus Gunn's syndrome

The authors examine a clinical case of the Marcus Gunn phenomenon, characterized by the lid retraction when the patient closes her mouth. The peculiarity of this clinical case would consist in a partial synkinesis involving the masseter and temporal muscles.     

Marcus Gunn jaw-winking phenomenon: a new supplemental test in the preoperative evaluation.

PURPOSE: To introduce a new method for the evaluation of Marcus Gunn jaw-winking ptosis that more precisely defines the severity of blepharoptosis. METHODS: A retrospective review of 16 consecutive patients with Marcus Gunn jaw-winking ptosis presenting to our institution between 1993 to 1999 was performed. The position of the affected eyelid was observed after applying a technique of jaw immobilization and disruption of fusion with temporary occlusion of the ipsilateral side. RESULTS: In patients presenting with mild to moderate Marcus Gunn jaw-winking, the majority (62.5%) demonstrated a positive test, uncovering complete or near complete ptosis. Test results were partially positive in 3 patients (18.8%) with increased but not complete ptosis and negative in 3 patients (18.8%) with no change in eyelid position. CONCLUSIONS: Blepharoptosis associated with Marcus Gunn jaw-winking phenomenon is often more severe than found by conventional clinical evaluation. This finding may explain the frequent undercorrection and unpredictable results following levator resection. In patients exhibiting a positive jaw-winking ptosis test, disappointing outcomes with levator resection may be avoided by instead proceeding with a frontalis suspension with levator disinsertion as recommended for ptosis with severe jaw winking.     

An unusual case of Marcus Gunn phenomenon]

The author gives a short review on the course of the disease and the typical symptoms of regular Marcus Gunn phenomenon i.e. the retraction of an usually ptotic lid when the patient opens his mouth or moves his jaw to the healthy side of his face. He then reports on a boy now aged 3 and a half that had suffered from Marcus Gunn phenomenon since his birth, although the disease almost disappeared in the first years of his life. Only a short time before the parents noticed again the phenomenon, occurring now in a modified version; the retraction of the lid appears mainly then when the child pulls himself up from a lying position or raises the arm of this side where the ptosis is located.     

Bilateral Marcus Gunn jaw winking synkinesis with monocular elevation deficiency: a case report and literature review

Marcus Gunn jaw winking synkinesis (MGJWS) occurs due to an aberrant innervation of the levator palpebrae superioris muscle by a branch of the motor division of the trigeminal nerve that supplies the muscles of mastication. MGJWS is mostly unilateral occurring in isolation and is less frequently associated with ocular or systemic abnormalities. Although MGJWS is mostly unilateral, few bilateral cases have been reported. Here we describe a rare case of bilateral MGJWS in an 18 year-old male patient with asymmetric bilateral ptosis and monocular elevation deficiency in the right eye.     

Bilateral keratoconus: a case report

Among corneal dystrophies, the keratoconus is one of the most frequently observed among young adults. A clinico pathological case is reported in a 13-year-old-girl of African origin. The diagnosis of bilateral keratoconus was established based on the obvious changes of the corneal curvature and thickness. After an unsuccessful attempt to improve vision with contact lenses, a keratoplasty was finally performed on one side to remove the pathological cornea. Its histopathological study found the characteristic changes of keratoconus: breaks of Bowman's layer and corneal thinning.     

单眼双上转肌麻痹伴下颌-瞬目综合征一例

患儿,男,6岁,因“右眼睑下垂6年”于2015年9月14日来我院眼科住院治疗。出生史：患儿为35周双胎顺产,另一胎为女孩,均无缺氧史。出生体质量：2300 g。家族史：患儿母亲是左侧的下颌-瞬目综合征（又称Marcus-Gunn综合征,简称MGP）,无斜视。患儿同胞姐姐,无斜视,无MGP。查体：裸眼视力（UCVA）：右眼0.1,左眼1.0;屈光度：右眼+1.50-0.75×12,左眼+1.00-0.50×172。角膜映光法：-15°L/R15°。第一眼位为右眼下斜;左眼为主视眼。交替遮盖：右眼外下至正中,左眼外上至正中。左眼注视时,伴右眼睑下垂并右眼下转（见图1A）。右眼注视时,右眼睑下垂消失并左眼上转。双眼球运动：右眼内上、上方、外上方均上转受限（-2）（见图2）。双眼Bell征（+）,右侧减弱。患儿咀嚼时,右上睑呈节律性上抬（见图1A-B）,伴有右侧附耳（见图1C）。交替遮盖加三棱镜法：5 m 和33 cm 检查距离均为-30△L/R30△。右下睑约1/2睫毛倒入眼球。诊断为“右眼双上转肌麻痹（double elevator palsy,DEP）、MGP、右下睑倒睫”,在全身麻醉下行牵拉试验（-）,排除下直肌受限。因患儿不仅存在双上转肌麻痹还合并有外斜视,因此仅做改良Knapp术式是不能同时解决外斜视的,所以术中将右眼内直肌向上方转位于上直肌的鼻侧、外直肌转位于上直肌颞侧并平行后退8.5 mm（见图3）。     

Bilateral uveal melanoma: a case report

BACKGROUND: The occurrence of bilateral uveal melanoma is rare. This is the first reported case of bilateral melanoma of the choroidea in Austria. METHODS: The chart of a 62-year-old male patient with bilateral melanoma of the choroidea was reviewed. RESULTS: In October 1992, a patient was diagnosed with a choroidal melanoma in the left eye. After two treatments with a ruthenium applicator in 1992 and 1995, the left eye was enucleated in 1999 due to recurrent growth of the choroidal melanoma. In September 2005, the patient presented with a primary choroidal melanoma in the remaining right eye. Sonography of the liver as well as CCT and bone marrow scintigraphy showed no sign of metastatic disease. A ruthenium-106 brachytherapy was performed and the size and height of the melanoma showed decreases. In July 2006, the patient developed metastatic disease and died the following month due to metastasis of the liver. In the genetic analysis, monosomy 3 was detected in both melanoma, an amplification of c-MYC of chromosome 8 was detected in the melanoma of the right eye only. CONCLUSION: Bilateral uveal melanoma is a rare diagnosis. This case shows the importance of a thorough and recurrent examination of the second eye. The results of the genetic analysis are discussed.     

Bilateral ocular myiasis interna caused by botfly (Oestrus ovis): a case report

The sheep nasal botfly Oestrus ovis is the commonest of several species of dipteran fly whose larvae are obligatory parasites in the nasal cavities and frontal sinuses of sheep but may cause infestation (myiasis) in man, commonly as external infestations and rarely, involves inner coat of the eye (Ocular myiasis interna). We report an imported case of Bilateral Ocular myiasis interna in an Indian boy.     

Bilateral complete isolated cryptophthalmos: a case report

Cryptophthalmos is a condition of congenital eyelid malformation most commonly accompanied by syndactyly, urogenital anomalies, and cognitive impairments as in Fraser syndrome. We report on a patient with characteristic features consistent with autosomal dominant bilateral complete isolated cryptophthalmos. This patient represents only the sixth documented case of bilateral complete isolated cryptophthalmos. Defining characteristics of this variety are discussed, including bilateral central dimpling over the globes, normal eyebrow growth, and the absence of cognitive impairment. We introduce phenotypic features that distinguish bilateral isolated cryptophthalmos from other forms and discuss its relatively favorable prognosis.