Eye bobbing associated with jaw movement.

Two patients were treated for a previously unreported disorder believed to be related to Marcus Gunn jaw-winking. The first, a 9-month-old infant with left congenital blepharoptosis without jaw-winking and with normal ocular motility had an up and down movement of the left globe synchronous with nursing movements of the jaw. The second was a 5-year-old girl with left blepharoptosis, jaw-winking, and left double elevator palsy who had up and down movements of both the left upper lid and the left globe synchronous with chewing. The left globe movements were most prominent in the field of vertical action of the superior rectus muscle and persisted after levator excision and fascia lata sling procedures. The possible etiology of the Marcus Gunn jaw-winking phenomenon is discussed and related to our cases of eye bobbing. The eye bobbing probably is caused by abnormal innervation to the superior rectus muscle produced by jaw movements in a manner analogous to the abnormal stimulation of the levator muscle in jaw-winking. The similar embryologic development and innervation of the levator and superior rectus muscles add credence to this theory.

Essential fatty acid deficiency associated with total parenteral nutrition.

Essential fatty acid deficiency is a clinical and biochemical entity encountered in both adults and children. Especially at risk are those patients maintained by fat-free total parenteral nutrition. Linoleic acid is the substance most responsible for the deficien state and essential to its correction. A ratio of trienoic-tetraenoic fatty acids of 0.4 or greater is diagnositc of a chemical deficiency. A severe deficiency affects polyunsatured fatty acids, in both plasma and tissues and, thus, many systems of the body. Mulitple blood transfusions have not proved sufficient to correct chemical deficiency. A recently marketed, commercially available fat supplement, however, may be useful in preventing the problem.