Patients with MGJW present with unilateral ptosis at rest. When the patient moves the jaw sideways or with protruding the tongue, clenching the teeth, swallowing, or chewing, there is a paradoxical synkinetic elevation of the ptotic eyelid.  The etiology is not clear but appears to represent a congenital cranial dysinnervation disorder where aberrant innervation of the ocular and facial musculature results from the abnormal development of cranial nerve nuclei or their axonal connections. Surgical management is often unsatisfactory.  It can be directed separately to the droopy eyelid or to the synkinesis and depends upon the degree of ptosis and the severity of the synkinesis.