OBJECTIVE To report the outcomes of a management protocol for Marcus Gunn jaw winking synkinesis. METHODS The records of 31 patients (16 female, 15 male) presenting to a tertiary referral center with Marcus Gunn jaw winking synkinesis between 1993 and 2003 were retrospectively analyzed. Generally, patients with mild wink and a small degree of ptosis underwent unilateral upper eyelid retractor surgery. Patients with a moderate or marked wink and ptosis underwent bilateral levator weakening procedures and brow suspension. Patients were assessed and treated for amblyopia and vertical strabismus before ptosis surgery. RESULTS Mean patient age was 11.23 years (median, 8 years; range, 10 weeks to 31 years). Ipsilateral hypotropia was noted in 8 patients (26%), with a median visual acuity in the ptotic eye of 20/30 (range, 20/20 to 20/40), compared with 20/20 in those without hypotropia. Patients who underwent unilateral surgery had good correction of ptosis, with equal palpebral apertures and symmetrical contour but had a detectable wink on formal testing. Patients who underwent bilateral surgery had equal palpebral apertures and symmetrical contour, with wink elimination. Mean follow-up was 31 months (all patients) and mean postoperative follow-up was 22 months. CONCLUSIONS Patients with Marcus Gunn jaw winking synkinesis can present at a wide age range. There may be an associated vertical muscle imbalance, which should be managed before ptosis surgery to avoid ptosis undercorrection and allow amblyopia management. Nearly all patients use the synkinesis to reduce the underlying true ptosis to a less noticeable "habitual" ptosis or to maintain binocularity. Surgical approach will differ, depending on whether the synkinesis, ptosis, or both are the main concern. Satisfactory results with a low complication rate can be achieved with the use of this management protocol.