The Bell's phenomenon is normal in nine patients, where four are Bimatoprost user (100%), four are Latanoprost users (57.
01% Ptosis None 3(75) Mild 1(25) Periorbital Skin Color No 3(75) Yes 1(25) Periorbital Fat Show No -- Severe 4(100) Eyelashes No Change 1(25) Thicker, Darker, Longer 3(75) Spontaneous Blinking Normal 2 (50) Average 1(25) Incomplete 1(25) Bell's phenomenon Present 4(100) Abnormal -- Absent -- Lids margin Meibomian -- Meibomian and 2(50) Telangiectasia Normal 1(25) Telangiectasia 1(25) Conjunctiva Conjuctivochalasis -- Inflammation (Injected) 1(25) Normal 3(75) Cornea Normal 1(25) Fluorescein Staining 3(75) Iris Change 1 (25) Same 3 (75) Prostaglandins (%) Latanoprost 0.
Bilateral Bell's phenomenon
was positive with drooling of saliva from both angles of mouth without wrinkling on forehead, naso-labial folds on both sides and inability to smile.
Ptosis examination included: lid fissure height, eyelid crease height, upper lid margin to reflex distance (MRD), scleral show, levator function, lagophthalmos, jaw winking and Bell's phenomenon (4+ implies complete disappearance of the cornea and zero corresponds to absence of Bell's phenomenon), inspection for abnormal head posture (e.
Exclusion criteria included weak Bell's phenomenon (less than 50% of normal), positive phenylephrine test, jaw winking phenomenon, blepharophimosis syndrome, systemic or myopathic disorders with secondary ptosis such as myotonic dystrophy, myasthenia gravis, chronic progressive external ophthalmoplegia, and Graves' disease, history of intra or extra ocular and eyelid surgery, sharp or blunt trauma to the eyelids, eyelid tumors and scars and patients with vertical squint.
Physical examination showed left facial weakness with Bell's phenomenon
and left sensorineural hearing loss.
However, the response may be the Bell's phenomenon
rather than eye closure.
Weakness of the orbicularis oculi muscle leads to difficulty in closing the eye and exaggeration of Bell's phenomenon
, the normal upward movement of the eye with lid closure.
9) frontalis sling was not done due to absence of Bell's phenomenon.
18,16) Crutch glasses were given for 2 patients with CPEO and frontalis sling was not done due to absence of Bell's phenomenon.
All complications of blepharoptosis were noted in form of cosmetic appearance, under correction, lid fold, and bell's phenomenon
, synkinetic movement, lid lag, lagophthalmos, lid notching, entropion, prolapsed of fornix, over correction, exposure keratitis, fat prolapse, sling exposure, granuloma and infection.
Neurological examination revealed intact Bell's phenomenon
indicating supranuclear lesion in DEP.