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Clinical Features Associated with the Jaw Winking Syndrome

Correspondence: Requests for reprints should be addressed to: Leonard G. Digout, BSc, OC(C), COMT, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Saudi Arabia. e-mail: kkeshres{at}awalnet.net.sa

Background: The jaw winking phenomenon is most often described as blepharoptosis of the upper lid associated with stimulation of the ipsilateral pterygoid muscle. Other clinical features are known to be associated with this entity. They include strabismus, amblyopia and refractive error.

Patients and Methods: A total of 33 patients were identified via a retrospective chart review. The data collected included the presence and type of any associated strabismus, visual acuity during the follow-up period, refractive error at last examination, affected eye, and sex.

Results: Strabismus was found in 69.7% of the patients with double elevator palsy being the most common variety. Refractive errors fell within a normal range for this age group. Amblyopia was found in 51.5% and was most commonly associated with strabismus and/or anisometropia. There was a predominance of affected left eyes (57.6%) and females (63.6%).

Discussion: Because of the prevalence of elevation deficiency, one should pay special attention to the extraocular motility pattern when examining a patient with the jaw winking phenomenon. Additionally, one should be aware that amblyopia is common especially in the patients with associated strabismus and/ or anisometropia. The documented association of the jaw winking with Duane syndrome as well as the similar laterality and sex distribution data are an interesting phenomenon.

Key words: jaw winking, strabismus, amblyopia, refractive error