[Prevalence of Bell's phenomenon and changes after surgery for aponeurotic ptosis]. / Prévalence du réflexe de Charles Bell et évolution postopératoire dans la chirurgie du ptosis aponévrotique.

BACKGROUND: Ptosis surgery is common in oculoplastics, and its most threatening complication is corneal ulceration. Several factors have been associated with postoperative corneal disorders, such as the strength of the orbicularis muscle, the type of surgery performed, and the Bell's phenomenon reflex (BPR). The goal of this study was to investigate the prevalence of physiological BPR, absence of BPR, and presence of inverse BP in patients undergoing surgery for aponeurotic ptosis. The changes in the BPR during the postoperative course as well as the occurrence of corneal complications were also studied. MATERIALS AND METHODS: A retrospective study was conducted at the University Hospital of Nice from January 2018 to December 2023. Patients operated on for aponeurotic ptosis were included. Patients with myogenic or neurogenic ptosis or with missing data were excluded. Data were recorded preoperatively and one month postoperatively and included: eyelid height, orbicularis muscle strength, prevalence of BPR, lack of BPR, inverse BPR, and postoperative corneal ulcer. RESULTS: Ninety-eight eyelids of 57 patients were included over the study period. Preoperatively, the prevalence of physiological BPR, no BPR, and inverse BPR were 71.4%, 18.4%, and 10.2%, respectively. At one month postoperatively, 30.6% of patients experienced a change in BPR (p=0.004). The postoperative prevalence of BPR, no BPR, and inverse BPR were 77.5%, 17.4%, and 5.1%, respectively. The rate of postoperative corneal ulcers was 1.02%. CONCLUSION: Among patients operated on for aponeurotic ptosis, the prevalence of physiological BPR was 71.4% preoperatively. Approximately one-third of patients experienced a change in BPR one month postoperatively with a postoperative physiological BPR prevalence of 77.5%. The rate of corneal complications was low.

Late-onset inverse Bell's phenomenon after upper eyelid trauma.

Bell's phenomenon evaluation is an important part of preoperative patient assessment for eyelid surgeries. Inverse Bell's phenomenon is a rare manifestation, usually observed in the early postoperative period following ptosis restoration surgeries, in pathological conditions, and in a small proportion of normal population. In the current case report, a 6-year-old girl presented with late-onset posttraumatic inverse Bell's phenomenon, 6 months after facial trauma with posttraumatic lagophthalmos. Rehabilitative blepharoplasty for the correction of lagophthalmos led to the restoration of inverse Bell's phenomenon 3 months postoperatively. Potential causative mechanisms are discussed for this late-onset manifestation of inverse Bell's response.

Transient Inverse Bell's Phenomenon Following Frontalis Sling-Suspension Ptosis Surgery: A Rare Ophthalmic Phenomenon.

INTRODUCTION: Inverse Bell's phenomenon is a rare ophthalmic phenomenon where downward instead of upward movement of the eyeball occurs during eyelid closure. It may be associated with peripheral facial nerve palsy, conjunctival scarring, and ptosis surgery. CASE REPORT: A 9-year-old male patient with right upper-lid congenital ptosis developed inverse Bell's phenomenon 2 days after frontalis sling-suspension ptosis surgery. At the 3-week postoperative visit, there had been spontaneous resolution of the inversion of Bell's phenomenon without any corneal complication. CONCLUSION: Inverse Bell's phenomenon, more often reported to be associated with levator-resection surgery, may develop following frontalis sling-suspension ptosis surgery. Close monitoring and frequent instillation of topical lubricants are necessary to prevent exposure keratopathy until the resolution of inverse Bell's phenomenon in patients with lagophthalmos after ptosis surgery.