A Novel Co-occurrence of Jaw-Winking Ptosis and Duane-Like Synkinesis in Möbius Sequence

Excerpt

To the Editor: A 5-y-old child presented with a history of bilateral foot deformity since birth. There was difficulty in breast feeding due to poor sucking and developmental delay. Examination showed masklike dysmorphic facies (Fig. 1a). Associated anomalies were high arched palate, clinodactyly, micrognathia, fissured tongue and bilateral equinocavo-varus foot deformity (Fig. 1b). Ocular examination showed telecanthus with anti-mongoloid slanting of palpebral fissures. There were synkinetic eyelid movements accompanying jaw movements (Marcus-Gunn phenomenon) in the right eye (Fig. 1a). Ocular motility examination showed limitation of abduction in both the eyes and elevation in the right eye. The left eye showed an upshoot on attempted adduction simulating a Duane-like synkinesis. Corneal sensations were diminished in both the eyes with minimal lagophthalmos and exposure keratopathy in the left eye. A diagnosis of Möbius syndrome with various cranial nerve involvements was made.

…