Journal List > J Korean Ophthalmol Soc > v.48(12) > 1007991

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Park, Lee, Choi, and Oum: Bell's Phenomenon and Conjunctival Injury in Screening Examination for Retinopathy of Prematurity
Original Article

J Korean Ophthalmol Soc 2007;48(12):1694-1698.

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.12.1694

Bell's Phenomenon and Conjunctival Injury in Screening Examination for Retinopathy of Prematurity

Sung Who Park, M.D., Ji Eun Lee, M.D., Hee Young Choi, M.D., Boo Sup Oum, M.D.

Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea

Address reprint requests to Ji Eun Lee, M.D., Department of Ophthalmology, Pusan National University Hospital, #1-10 Ami-dong, Seo-gu, Pusan 602-739, Korea Tel: 82-51-240-7326, Fax: 82-51-242-7341, E-mail: jlee@pusan.ac.kr

Received 23 April 2007       Accepted 14 August 2007

Copyright © 2007 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Bell's phenomenon (BP) was known not to be common in premature babies. If manifested, it may be detected on screening examinations for retinopathy of prematurity (ROP), indicating that conjunctival injury may have occurred. We studied correlations with BP and conjunctival injuries.

Methods

Ninety-two eyes of 46 premature babies, ranging from 36 to 38 weeks of gestational age, underwent screening examination for ROP. Rotation of the eyeball was evaluated with an inserted speculum.
After observing temporal and nasal ora serrata with indentation, conjunctiva was examined for any possible damage.

Results

BP was observed in 50 of 92 subjects (54%). Notable conjunctival hemorrhage was found in 7 of
50 eyes (14%) with BP and in 2 of 42 eyes (5%) without BP. Stronger BP is correlated with severe injury to the conjunctiva (p<0.001).

Conclusions

Bell's phenomenon (BP) may manifest in screening examinations for ROP. Manifestations of BP are related to conjunctival injury.

Keywords: Bell's phenomenon, Retinopathy of prematurity

References

1. Bell C. On the motions of the eye in illustration of the uses of the muscles and nerves of the orbit. Philos Trans R Soc Lond. 1823; 113:166–86.
2. Francis IC, Longhhead JA. Bell's phenomenon: A study of 508 patients. Aust J Ophthalmol. 1984; 12:15–21.
3. Ferrer JA. Conclusions from Bell's phenomenon variants. Trans Am Acad Ophthalmol Otolaryngol. 1973; 77:714–20.
4. Snir M, Kremer I, Kuperman A, et al. Bell's phenomenon in newborns and premature babies. Br J Ophthalmol. 1996; 80:553–5.
crossref
5. American Academy of Pediatrics. Section on Ophthalmology. Screening examination of premature infants for retinopathy of prematurity. Pedriatrics. 2001; 108:809–11.
6. Maheshwari R, Kumar H, Paul VK, et al. Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi. Natl Med J India. 1996; 9:211–3.
7. Termote JUM, Schalij-Delfos NE, Wittebol-Post B, et al. Surfactant replacement therapy, a new risk factors in developing retinopathy of prematurity? Eng J Pediatr. 1994; 153:113–6.
8. Rekha S, Battue RR. Retinopathy of prematurity, Incidence and risk factors. Indian Pediatrics. 1996; 33:999–1003.

Figure 1.
Grading of Bell's phenomenon.: (A) grade 0, no response, (B) grade 1, minimal response or the corneal center is visible, (C) grade 2, full response or the corneal center is invisible.
jkos-48-1694f1.tif
Figure 2.
Grading of conjunctival injury.: (A) grade A, minimal injury. (B) grade B, conjunctival petechia. (C) conjunctival hemorrhage or laceration.
jkos-48-1694f2.tif
Table 1.
Baseline clinical characteristics of study patients
Male:Female (eyes) 48:44
Birth weight (gm) 1471.8 (643-2830)
Gestational age (wks) at birth 31.0 (25-37)
Gestational age (wks) at exam 36.7(36-38)
Table 2.
The grade of conjunctival injuries by location
Grade of CI Right eye Left eye
Nasal Temporal Nasal Temporal
0 26 33 31 28
1 15 10 14 13
2 5 3 1 5

* CI=conjunctival injury.

Table 3.
Relationship between the grade of conjunctival injury and the grade of Bell's phenomenon in the screening examination for retinopathy of prematurity
Grade of Bell's phenomenon Grade of conjunctival injury (eyes)
0-1 2
0 40 2
1 23 3
2 20 4

* P<0.001.

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