Purpose

To evaluate whether functional improvement predicts patient satisfaction in Marcus Gunn syndrome, and to assess the impact of postoperative symmetry, residual synkinesis, and surgical approach.

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Methods

A retrospective analysis of six patients with Marcus Gunn syndrome was performed. All underwent levator excision with frontalis suspension, using unilateral or bilateral approaches. Outcomes included eyelid position, degree of synkinesis (complete, partial, or persistent), symmetry, and patient-reported satisfaction.

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Results

Six patients were included; five underwent bilateral surgery and one unilateral. Functional improvement was observed in all cases. Synkinesis reduction showed a consistent pattern with an approximate average improvement of 80%, although two patients reported complete resolution.

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Conclusion

Patient satisfaction correlated more strongly with postoperative symmetry than with functional improvement or synkinesis reduction alone. Higher satisfaction was reported in patients with better symmetry, even in the presence of residual synkinesis. The unilateral case showed poorer dynamic control and lower perceived symmetry.Functional improvement alone does not predict patient satisfaction. Symmetry appears to be the main determinant of perceived success. The observed variability in synkinesis improvement suggests intrinsic limitations of current techniques, likely related to differences in aberrant innervation and disease severity. Bilateral approaches may better address the dynamic component. These findings support individualized surgical planning and realistic expectation management.

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