Beyond the blink: eyelid & ocular surface – a toxic relationship?
Author: Bhavna Sharma
Base Hospital / Institution: University Hospital of Southampton, United Kingdom
ePoster presentation
Abstract ID: 25-331
Purpose
To illustrate the complex interplay between periocular radiotherapy, meibomian gland dysfunction, & ocular surface vulnerability through a case of severe corneal ulceration following ptosis surgery in a patient with variable Bell’s phenomenon, supplemented by a focused literature review.
Methods
A 21-year-old male, previously treated with orbital radiotherapy for childhood rhabdomyosarcoma, underwent surgical correction of right upper eyelid ptosis. Despite demonstrating an intact Bell’s phenomenon in clinic, he developed significant lagophthalmos & exposure keratopathy after frontalis sling surgery. Initial management included intensive lubrication & a lateral tarsorrhaphy. During sedation for further surgery, absence of Bell’s phenomenon was observed, prompting revision to a more extensive tarsorrhaphy. A literature review was conducted examining the effects of radiotherapy on the eyelid microbiome, meibomian gland function, & the variability of Bell’s phenomenon under sedation & sleep.
Results
Corneal ulceration developed secondary to sedation-induced and likely nocturnal attenuation of Bell’s phenomenon, despite normal clinical assessments. Radiotherapy-related meibomian gland dysfunction and blepharitis exacerbated ocular surface compromise, delaying epithelial healing. Radiotherapy can cause long-term glandular dysfunction & microbiome alterations, contributing to ocular surface disease. Moreover, Bell’s phenomenon varies under sedation, diminishing its protective role. Stepwise surgical interventions, combined with intensive ocular surface optimisation, ultimately stabilised the cornea.
Conclusion
This case highlights the concealed risk of corneal exposure in patients with prior orbital radiotherapy, even when Bell’s phenomenon appears intact. We reinforce the necessity of accounting for perioperative variability of Bell’s reflex and the compounded ocular surface vulnerability induced by radiotherapy. Early multidisciplinary input and proactive protective strategies are vital to mitigate sight-threatening complications in this high-risk group.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Daniele | Lorenzano | University Hospital of Southampton |
