Transient Inverse Bell’s Phenomenon Following Frontalis Sling–Suspension Ptosis Surgery: A Rare Ophthalmic Phenomenon

INTRODUCTION: Inverse Bell’s phenomenon is a rare ophthalmic phenomenon where downward instead of upward movement of the eyeball occurs during eyelid closure. It may be associated with peripheral facial nerve palsy, conjunctival scarring, and ptosis surgery. CASE REPORT: A 9-year-old male patient with right upper–lid congenital ptosis developed inverse Bell’s phenomenon 2 days after frontalis sling–suspension ptosis surgery. At the 3-week postoperative visit, there had been spontaneous resolution of the inversion of Bell’s phenomenon without any corneal complication. CONCLUSION: Inverse Bell’s phenomenon, more often reported to be associated with levator-resection surgery, may develop following frontalis sling–suspension ptosis surgery. Close monitoring and frequent instillation of topical lubricants are necessary to prevent exposure keratopathy until the resolution of inverse Bell’s phenomenon in patients with lagophthalmos after ptosis surgery.