Blepharoptosis or Ptosis or drooping upper eyelid is a common eyelid disease, Ptosis can affect one eye or both eyes. Ptosis describes an abnormally low upper eyelid, resulting in a very sleepy eyed look. While in the initial stages, you may just look less alert, in the later stage this may lead to tired eyes, more watering from eyes and even obstruction to vision as the droopy eyelid prevents patients from seeing. In children (toddlers, infants, baby, children), in severe cases of ptosis, the drooping eyelid can cover part or all of the pupil and interfere with vision, resulting in amblyopia or a lazy eye, in which vision (sight) can get permanently impaired. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development. If a droopy eyelid is present at birth or within the first year of life, the condition is called congenital ptosis. Any ptosis that develops over a period of days or weeks can signal a serious medical problem and needs further neurologic and physical evaluation.
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Congenital Ptosis occurs when the muscles that raise the eyelid (levator palpebrae superioris - called LPS - and superior tarsal muscles) are not strong enough to do so properly. Congenital ptosis is hereditary in some forms. In 1883, Marcus Gunn described a 15-year-old girl with a peculiar type of congenital ptosis that included an associated winking motion of the affected eyelid on the movement of the jaw (associated neurological abnormality). This synkinetic jaw-winking is called the Marcus Gunn Jaw winking phenomenon. Patients with Marcus Gunn jaw-winking syndrome have variable degrees of blepharoptosis in the resting, primary position. Although Marcus Gunn jaw-winking syndrome is usually unilateral, it can present bilaterally in rare cases. The wink reflex consists of a momentary upper eyelid retraction or elevation to an equal or higher level than the normal fellow eyelid upon stimulation of the ipsilateral pterygoid (jaw) muscle. This response is followed by a rapid return to a lower position. The amplitude of the wink tends to be worse in downgaze. This rapid, abnormal motion of the eyelid can be the most disturbing aspect of the jaw-winking syndrome. The wink phenomenon may be elicited by opening the mouth, thrusting the jaw to the contralateral (opposite) side, jaw protrusion, chewing, smiling, or sucking. This wink phenomenon is often discovered early, as the infant is bottle-feeding or breastfeeding.
In this video, Dr. Debraj Shome, one of the top / best oculoplastic surgeons in the world (currently based in Mumbai, India), demonstrates a new type of ptosis surgery, in a child with a right sided congenital ptosis (droopy eyelid), associated with a synkinetic Marcus Gunn Eyelid flickering movement (when the child yawned, opened his mouth or was eating).
