Inverse Bell's Phenomenon Following Repeated Levator Resection Surgery

Kyung Sun Na; So Jung Shin; Suk-Woo Yang

doi:10.3341/jkos.2008.49.2.352

Journal List > J Korean Ophthalmol Soc > v.49(2) > 1008195

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Na, Shin, and Yang: Inverse Bell's Phenomenon Following Repeated Levator Resection Surgery

Original Article

J Korean Ophthalmol Soc 2008;49(2):352-356.

Published online: 31 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.2.352

Inverse Bell's Phenomenon Following Repeated Levator Resection Surgery

Kyung Sun Na, M.D., So Jung Shin, M.D., Suk-Woo Yang, M.D.

Department of Ophthalmology, Gangnam St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Suk-Woo Yang, M.D., Department of Ophthalmology, Gangnam St. Mary's Hospital, College of Medicine, The Catholic University #505 Banpo-dong, Seohho-gu, Seoul 137-040, Korea Tel: 82-2-590-1523, Fax: 82-2-590-1544, E-mail: yswoph@catholic.ac.kr

Received 31 May 2007 Accepted 10 October 2007

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

We report a complication involving a transient inversion of Bell's phenomenon observed following extensive levator resection performed to treat aponeurotic ptosis.

Case summary

A 22 year old female patient complained of ptosis of both eyelid. The levator function of both lid was good, and a normal corneal protection mechanism was observed. The patient underwent levator resection and several reoperation because of asymmetrical lid height and entropion. Inversion of Bell's phenomenon was observed in the postoperative period. Eye with Bell's phenomenon reverted to normal within 1 month after final operation, and there were no corneal erosion. Lubricating eyedrop was used frequently during the postoperative period.

Conclusions

It is important to consider that abnormal cases of Bell's phenomenon sometimes manifest after repetitive and extensive levator resection and to keep a close watch on the cornea while providing it with ample lubrication.

Keywords: Inverse Bell's phenomenon, Levator resection, Ptosis

References

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Figure 1.

(A) Preoperative view of a 22-year-old female patient with bilateral aponeurotic ptosis with good levator function measured 12 mm. (B) One month following final surgery. Postoperpative photograph showing satisfactory lid height in the primary gaze of both eyes.

Figure 2.

(A) Postoperative view of a patient immediately after suture removal following the third levator resection in the right eye and the second operation in the left eye showing inverse Bell's phenomenon on eye closure. The lagophthalmos in the right eye enables observation of the inversion of Bell's phenomenon. (B), (C), (D) Both eyeballs roll downward on attempted voluntary eyelid closure against resistance.

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