Bilateral jaw winking reflex in association with multiple congenital anomalies.

In the textbook descriptions of the jaw winking phenomenon of Marcus Gunn, it is sometimes stated that the phenomenon affects only one eye. This is not entirely correct. Though it is unilateral in the vast majority of cases, 7 cases have been reported in which it was bilateral.1-7 The jaw winking phenomenon may be combined with anomalies of the extraocular muscles, in addition to the ptosis of the upper lid, which was found to be absent in only 7 or 8 cases recorded in the literature. Congenital paralysis of the homolateral elevators is frequently observed; occasionally there is a paresis or paralysis of other extraocular muscles or even an external ophthalmoplegia. In a few scattered instances, miosis of the homolateral pupil, Horner's syndrome, miosis of the contralateral pupil, and coloboma of the iris have been described in association with the jaw winking phenomenon. However, a careful search of the