Inverse Bell's Phenomenon: Rare Ophthalmic Finding Following Ptosis Surgery.

Bell's phenomenon is protective reflex in which the globe is turned upwards and slightly outwards during the eyelid closure to avoid corneal exposure. In Inverse Bell's phenomenon, the eye moves downward instead of upward, this may be seen in the normal population, patients with Bell's palsy or following conjunctival scarring. We hereby present the unusual complication of transient inversion of Bell's phenomenon following extensive levator resection surgery performed for congenital ptosis. A 24-year-old male was undergone ptosis correction surgery. On postoperative day two, ocular examination revealed down rolling of eye ball during eyelid closure. It underwent spontaneous resolution within four weeks without any corneal complication. The patients were given frequent lubricating eye drops during this period and advised frequent follow-up for early diagnosis of corneal complication. Here we highlight an inverse Bell's phenomenon following levator resection surgery, its possible mechanism and risk of corneal complication.