Inverse Bell’s Phenomenon Following Eyelid Surgery: A Case Series and Review of Mechanisms and Management
Author: Flavia Quaranta-Leoni
Base Hospital / Institution: Dept. of Ophthalmology – Tor Vergata University of Rome
ePoster presentation
Abstract ID: 25-246
Purpose
Objective: To present four cases of postoperative inverse Bell’s phenomenon and investigate its underlying mechanisms, clinical relevance, and management strategies.
Methods
Methods: This case series includes three patients who developed inverse Bell’s phenomenon following levator resection for congenital ptosis, and one patient after Cutler-Beard reconstruction for a large upper eyelid defect. Postoperative progression was recorded, and potential aetiologies were reviewed in the context of current literature.
Results
Results: All patients exhibited inverse Bell’s phenomenon—characterised by downward rotation of the globe during eyelid closure—in the early postoperative period. In two cases, the phenomenon resolved spontaneously within weeks and without corneal complications. In the remaining two cases, it persisted at two- and five-year follow-up, respectively.
Conclusion
Conclusion: Inverse Bell’s phenomenon is a rare but clinically significant complication of upper eyelid surgery. While often self-limiting, persistent cases pose an increased risk of exposure keratopathy and require vigilant corneal protection and long-term follow-up. Temporary cases may result from postoperative oedema and hyperaemia disrupting the functional coordination between the levator palpebrae superioris and the superior rectus muscle. In contrast, persistent inverse Bell’s phenomenon may be due to iatrogenic injury to the superior rectus muscle or the oculomotor nerve, potentially altering trigemino-oculomotor pathways. Comprehensive pre- and postoperative assessment of Bell’s reflex is essential for early identification and appropriate management.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Antonella | Leonardi | Oftalmoplastica Roma |
| Francesco | Quaranta Leoni | Oftalmoplastica Roma and University of Ferrara |
