scholarly journals Inverse Bell’s phenomenon: a rare complication of levator resection surgery in a case of congenital ptosis

2019 ◽  
Vol 12 (11) ◽  
pp. e232451
Author(s):  
Ashi Morawala ◽  
Abhimanyu Sharma ◽  
Milind N Naik
Keyword(s):  
Postoperative Care ◽  
Ocular Surface ◽  
Rare Complication ◽  
Rare Event ◽  
Congenital Ptosis ◽  
Levator Resection ◽  
Plan Management ◽  
Bell's Phenomenon ◽  
Bell’S Phenomenon

A 27-year-old woman with moderate congenital ptosis and a positive Marcus-Gunn jaw winking reflex underwent levator resection surgery to correct the ptosis. Preoperatively, a normal Bell’s reflex was documented. Postoperatively, she developed an inverse Bell’s reflex and increased symptoms of ocular surface exposure. The Bell’s reflex normalised in a week, with resolution of the corneal exposure. Reversal of the Bell’s reflex can be an unforeseen complication following maximal levator resection. The early postoperative care in such cases is crucial, and the cornea must be protected from exposure changes. Accurate documentation of the Bell’s phenomenon preoperatively is vital to recognise this rare event and plan management.

scholarly journals The Relationship of Amount of Resection and Time for Recovery of Bell’s Phenomenon after Levator Resection in Congenital Ptosis

2017 ◽  
Vol 11 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Ruchi Goel ◽  
Divya Kishore ◽  
Smriti Nagpal ◽  
Sparshi Jain ◽  
Tushar Agarwal
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Close Monitoring ◽  
Female Ratio ◽  
Exact Test ◽  
Significant Difference ◽  
Levator Resection ◽  
Male Female Ratio ◽  
Bell's Phenomenon ◽  
Bell’S Phenomenon

Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed recovery can result in vision threatening corneal complications. Aim: To study the variability of Bell’s phenomenon and time taken for its recovery following levator resection for blepharoptosis and to correlate it with the amount of resection. Methods: A prospective observational study was conducted on 32 eyes of 32 patients diagnosed as unilateral simple congenital blepharoptosis who underwent levator resection at a tertiary care center between July 2013 and May 2015. Patients were followed up for 5 months and correction of ptosis, type of Bell`s, duration of Bell`s recovery and complications were noted. Results: The study group ranged from 16-25 years with 15:17 male: female ratio. There were 9 mild, 16 moderate and 7 severe ptosis. Satisfactory correction was achieved in all cases. Good Bell`s recovery occurred in 13 eyes on first post-op day, in 2-14 days in 19 eyes and 28 days in 1 eye. Inverse Bell`s was noted along with lid oedema and ecchymosis in 2 patients. Large resections (23-26mm) were associated with poor Bell`s on the first postoperative day (p=0.027, Fisher`s exact test). However, the duration required for recovery of Bell`s phenomenon did not show any significant difference with the amount of resection. (p=0.248, Mann Whitney test). Larger resections resulted in greater lagophthalmos (correlation=0.830, p<0.0001). Patients with recovery of Bell`s delayed for more than 7 days were associated with greater number of complications (p=0.001 Fisher`s Exact Test). Conclusion: Close monitoring for Bell`s recovery is required following levator resection.

Ocular surface characteristics and colonization in a burn center: A prospective cohort study

2021 ◽  
Author(s):  
Paola De La Parra-Colin ◽  
Alejandra Gonzalez-De La Torre ◽  
Rafael Franco-Cendejas ◽  
Alejandra Gonzalez-Veliz ◽  
Vania Zarza-Garcia ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ocular Surface ◽  
Cumulative Incidence ◽  
Pathogenic Microorganisms ◽  
Conjunctival Hyperemia ◽  
Acinetobacter Baumanii ◽  
Persistent Epithelial Defect ◽  
Burn Center ◽  
Bell's Phenomenon ◽  
Bell’S Phenomenon

Abstract We aimed to evaluate the characteristics and colonization by pathogenic microorganisms of the ocular surface in patients in a burn center and to determine their association with sedation, mechanical ventilation, and periocular burn. We prospectively evaluated 40 patients during an eight-month period. Five evaluations where performed, at baseline and weekly on four more occasions or until hospital discharge or death. On each visit, we assessed periocular burn, lid position, Bell’s phenomenon, Schirmer’s test, presence of chemosis, conjunctival hyperemia, and exposure keratopathy; conjunctival fornix swabs were taken for microbiology culture. Also, we documented the level of sedation, mechanical ventilation status, and systemic and ocular treatment. Absent Bell’s phenomenon and chemosis were significantly different at baseline in patients under mechanical ventilation, sedation, and in those with periocular burn. The cumulative incidence of exposure keratopathy was 22.5% and the cumulative incidence of ocular surface colonization by pathogenic microorganisms was 32.5%. Both outcomes were associated with mechanical ventilation and periocular burn. The most frequent pathogenic microorganisms in the ocular surface were Candida parapsilosis, Acinetobacter baumanii, and Pseudomonas aeuroginosa. We did not observe any case of persistent epithelial defect, infectious keratitis, corneal perforation or corneal opacity in this cohort. Results from our study may benefit future patients by allowing better risk stratification and treatment strategies for the ocular surface care in burn units.

scholarly journals Predicting Factors Influencing Visual Function of the Eye in Patients with Unresolved Facial Nerve Palsy after Upper Eyelid Gold Weight Loading

2021 ◽  
Vol 10 (4) ◽  
pp. 578
Author(s):  
Izabela Nowak-Gospodarowicz ◽  
Marek Rękas
Keyword(s):  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Upper Eyelid ◽  
Patient Age ◽  
Corneal Sensation ◽  
History Of ◽  
Gold Weights ◽  
Bell's Phenomenon ◽  
Bell’S Phenomenon

Implantation of gold weights into the upper eyelid is a proven method of treating lagophthalmos and exposure keratopathy in patients with unresolved facial nerve palsy. The aim of this study was to evaluate the factors affecting visual acuity and corneal complications in patients after upper eyelid gold weight lid loading. Material and methods: This prospective consecutive clinical study was conducted in years 2012–2018. In total, 59 people (40 women, 19 men aged 55.5 ± 17.4 years) meeting the inclusion criteria were treated with gold weights. The ordered multinomial logit model was used to analyze the factors affecting best-corrected visual acuity (BCVA) and degree of exposure keratopathy after surgery. The influence of the following variables was analyzed: patient age, etiology and duration of the facial nerve palsy, history of the previous eyelid surgery, degree of lagophthalmos in mm, presence of Bell’s phenomenon, and corneal sensation, Schirmer test results. Results: Implantation of gold weights into the upper eyelid effectively reduced lagophthalmos and exposure keratopathy in the study group (p < 0.001). BCVA was maintained or better in 95% of patients after surgery. Patient age, presence of the Bell’s phenomenon, and corneal sensation significantly affected the final BCVA (p < 0.1). The presence of Bell’s phenomenon and corneal sensation had a positive effect on the degree of keratopathy after surgery (p < 0.1). In turn, patient age and history of tarsorrhaphy were significant negative prognostic factors of exposure keratopathy and BCVA after surgery (p < 0.05). Etiology and duration of facial nerve palsy, degree of corneal exposure in mm, and results of the Schirmer test did not have a significant impact on the outcome after surgery (p > 0.1). Conclusions: The results of our study may help to answer the question of how to direct ophthalmologists and other specialists who refer to ophthalmologists for management advice in patients with facial nerve palsy. Elderly patients with a history of tarsorrhaphy who present with poor Bell’s phenomenon and/or a lack of corneal sensation should be the first candidates for immediate correction of lagophthalmos.

scholarly journals Lichen Planus as a Possible Rare Cause of an Ocular Disease

2019 ◽  
Vol 75 (4) ◽  
pp. 219-223
Author(s):  
Jana Nekolová ◽  
Markéta Středová ◽  
Miroslav Podhola ◽  
Naďa Jirásková
Keyword(s):  
Lichen Planus ◽  
Inflammatory Disease ◽  
Ocular Surface ◽  
Negative Impact ◽  
Rare Event ◽  
Chronic Inflammatory Disease ◽  
Mental Condition ◽  
Unknown Etiology ◽  
Ocular Involvement ◽  
Irreversible Damage

Lichen planus is a relatively common mucocutaneous papulosquamous disorder of unknown etiology that is thought to be immunologically mediated. Ocular involvement of lichen planus (LP) is a rare event, which can lead to irreversible damage to the ocular surface and loss of vision from cicatrizing blepharoconjunctivitis and corneal scarring. Steroids are the first treatment choice. Treatment with topical ciclosporin A is also a possible treatment. We report a case of 79-year-old woman who was treated for long lasting severe inflammatory disease of a ocular surface. It led to blindness of one eye and low vision of the second eye. The diagnosis was made thanks to correlation of biopsy results from oral and ocular surface. The patient was also diagnosed with middle-stage dementia. Negative impact of steroid therapy on mental condition of this patient was considered. On the other hand, dementia could cause worse compliance with recommended treatment regime. Chronic inflammatory disease of ocular surface requires long lasting treatment very often and it is sometimes not as effective as expected. Discovering etiological causes of the disease is a priority for the right treatment. We emphasize also the key role of physical and mental condition in management of ocular surface disease.

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