Reversal of inverse Bell’s reflex after sling removal and scar lysis in an 11-year-old patient: a case report
Keywords:
Blinking, Eyelid diseases, Keratitis, ReflexAbstract
We report a case of inverse Bell’s reflex of the right eye in an 11-year-old boy who underwent frontalis suspension ptosis correction at the age of 1 year and developed scarring secondary to exposure and infection of the sling implant 5 months later. At the age of 11 years, the patient had an episode of right eye infective keratitis secondary to corneal exposure and was first noted to have developed the inverse Bell’s reflex. The patient underwent removal of sling, scar lysis, and limited full thickness blepharotomy. At postoperative 11 months, the Bell’s reflex was completely normal. This suggests that eyelid scar tissue may contribute to the development of inverse Bell’s reflex and that scar lysis, despite delayed, may resolve the problem.
References
Gupta JS, Chatterjee A, Kumar K. Inverse Bell's phenomenon as a protective mechanism. Am J Ophthalmol 1965;59:931-3.
Pandey TR, Limbu B, Rajkarnikar Sthapit P, Gurung HB, Saiju R. Transient inverse Bell’s phenomenon following frontalis sling-suspension ptosis surgery: a rare ophthalmic phenomenon. Int Med Case Rep J 2019;12:325-7.
Shitole S, Jakkal T, Khaire B. Inverse Bell's phenomenon: rare ophthalmic finding following ptosis surgery. J Clin Diagn Res 2015;9:ND01-2.
Betharia SM, Sharma V. Inverse Bell’s phenomenon observed following levator resection for blepharoptosis. Graefes Arch Clin Exp Ophthalmol 2006;244:868-70.
Kumar DA, Agarwal A. Transient inverse bells phenomenon following frontalis sling surgery. Int J Ocul Oncol Oculoplasty 2016;2:258-9.
Morawala A, Sharma A, Naik MN. Inverse Bell’s phenomenon: a rare complication of levator resection surgery in a case of congenital ptosis. BMJ Case Rep 2019;12:e232451.
Na KS, Yang SW. Two cases of inverse Bell’s phenomenon following levator resection: a contemplation of the mechanism. Eur J Ophthalmol 2009;19:285-7.
Evinger C, Manning KA. Pattern of extraocular muscle activation during reflex blinking. Exp Brain Res 1993;92:502-6.
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