Inverse Bell's phenomenon observed following levator resection for blepharoptosis

Ptosis surgery is one of the more widely performed surgeries in ophthalmology. Preoperative lagophthalmos, Bell's phenomenon, corneal sensation and dry eye are important factors to be assessed in these cases, which influence the functional and cosmetic results. We herein describe the interesting complication of transient inversion of Bell's phenomenon observed following extensive levator resection performed for congenital ptosis. Three patients are described who underwent levator resection and showed an inversion of the Bell's phenomenon in the postoperative period, with the eye going down instead of up, during eyelid closure. The Bell's phenomenon reverted to normal in all three cases within 2 weeks and there were no corneal complications. The patients were given frequent lubricating eye drops during this period. It is important to look for variations in Bell's phenomenon in all cases of congenital ptosis, especially following levator resection. In cases with a poor or ineffective Bell's phenomenon, it is imperative to keep a close watch on the cornea along with copious lubrication during the early postoperative period.