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Case report
Inverse Bell’s phenomenon: a rare complication of levator resection surgery in a case of congenital ptosis
  1. Ashi Morawala,
  2. Abhimanyu Sharma and
  3. Milind N Naik
  1. Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India
  1. Correspondence to Dr Ashi Morawala; ashi.morawala{at}


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.

  • ophthalmology
  • plastic and reconstructive surgery
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  • Contributors The surgery was performed by MNN, in whose clinic the patient presented. The manuscript was written and completed by AM and figure collages were contributed by AS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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