AIM: To study the effect of clinical management of moderate-to-severe Marcus-Gunn syndrome (MGS) by anastomosis of levator and frontal muscles. METHODS: The medical records of 13 patients with moderate-to-severe MGS who underwent surgeries in our institute between 2000 and 2007 were reviewed retrospectively. They underwent unilateral anastomosis of levator and frontal muscles under local anesthesia. RESULTS: Postoperative follow-up periods ranged from 6 to 36 months, with an average of 12 months. All eyelids (100%) showed complete resolution of jaw-winking, ten eyelids (76.9%) had good correction of ptosis, with equal plapebral apertures and symmetrical contours, three (23.1%) showed residual mild ptosis (<2mm). CONCLUSION: For moderate-to-severe MGS, unilateral ana- stomosis of levator and frontal muscles provides satisfied correction of jaw-winking and ptosis.