Efficacy of frontalis suspension with silicone rods in ptosis patients with poor Bell's phenomenon

Shah, Khyati; Mukherjee, Bipasha

doi:10.4103/tjo.tjo_36_17

Cited by 12 publications

(2 citation statements)

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“…Bell’s phenomenon was evaluated by forcefully holding the upper eyelid in place while the participant attempted to close the eye tightly [ 16 ] . To standardize the classification, Bell’s phenomenon was evaluated using a similar technique by a single examiner who opened the upper eyelid approximately 6 mm (about half the corneal diameter).…”

Section: Methodsmentioning

confidence: 99%

Ocular surface lesions in clinical grades of Bell’s phenomenon

Faruk Yilmaz,

Oguz

2024

Med Hypothesis Discov Innov Ophthalmol

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Background: Bell’s phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell’s phenomenon that includes the inverse Bell’s phenomenon. Using this scale, we investigated the characteristics of Bell’s phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades. Methods: Bell’s phenomenon was classified into five grades: grade +2 (strong positive), grade +1 (weak positive), grade 0 (no Bell’s phenomenon, no eye movement), grade –1 (weak inverse), and grade –2 (strong inverse). In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 – 20 years, 21 – 40 years, 41 – 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade +2 Bell’s phenomenon were included in the symptomatic group. Results: We detected higher frequencies of grade +2, +1, and 0 in individuals aged 4 – 40, 41 – 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades (P < 0.001). Pairwise analysis revealed a significantly lower frequency of grade +2 in the age group > 60 years compared with the 4 – 20 and 21 – 40 year groups (both P < 0.05). Grade +2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes (P > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions (P < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all P < 0.001). However, the frequency of ocular surface lesions was comparable between sexes (P > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, +1, –1, and –2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade +1, –1, and –2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade +1, –1, and –2: 7 lesions). Conclusions: Using a simple, practical grading scale for Bell’s phenomenon that includes inverse Bell’s phenomenon, we observed that inverse Bell’s phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degree as a strong Bell’s phenomenon. Our observations imply that bilateral conjunctival calcifications/Vogt’s limbal girdle may be associated with grades 0 and +1 Bell’s phenomenon. Further large-scale studies are needed to determine the frequency of Bell’s phenomenon in the general population using this innovative, simple, practical grading scale, and to identify the protective or injurious effect of each grade on the ocular surface.

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Section: Methodsmentioning

confidence: 99%

Ocular surface lesions in clinical grades of Bell’s phenomenon

Faruk Yilmaz,

Oguz

2024

Med Hypothesis Discov Innov Ophthalmol

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“…This procedure is simple but there are certain issues which include bilateral surgery for symmetrical results, lack of crease formation, use of synthetic material in very young children and significant lagophthalmos leading to exposure. 8 MLR is useful alternative in selected patients with severe ptosis which refers to resection of the muscle above the Whitnall ligament. 9 In our present analysis, maximum levator resection (MLR) was done by a single surgeon.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Maximum Levator Resection in Severe Upper Eyelid Ptosis at a Tertiary Oculoplastic Service

Idris

Yaqoob²,

Sabir

et al. 2021

pak J Ophthalmol

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Purpose: To investigate the surgical outcomes of maximum Levator resection in cases of severe upper eyelid ptosis at a tertiary oculoplastic service. Study Design: Interventional case series. Place and Duration of Study: Department of Ophthalmology, Lady Reading Hospital, Medical Teaching Hospital, Peshawar January 2013 to December 2017. Methods: One hundred and twenty three eyes of 107 patients, who underwent maximum levator resection for severe congenital ptosis were included. Patients with missing or incomplete notes, patients with previous ptosis surgery and ptosis other than congenital were excluded. Maximum levator resection of the muscle above the Whitnall ligament was performed under local/general anesthesia. All patients had a minimum of 6 months and maximum of 5 years followup. The postoperative complications were recorded and followed. Post operative followup was done at day one, week one and at four weekly intervals till the end of the study. Results: Out of 123 eyes, satisfactory results (excellent or good) were obtained in 111 (90.1%) eyes. Majority of the patients (56.09%) were females. Mean Preoperative Levator function was 2.3 ± 1.1mm. Mean Preoperative MRD1 was ?0.1 ± 1.5 mm and mean postoperative MRD1 was 3.9 ± 01.0 mm. The commonest complication was over correction which occurred in 5 (4.06%) cases, under correction in 4 (3.25%), crease abnormality in 2 (1.62%) cases and entropion was seen in only one (0.81%) case. Success rate was 90.1% at 6 months to 5-years followup. Key Words: Blepharoptosis; Levator resection; Levator function.

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