The Relationship of Amount of Resection and Time for Recovery of Bell's Phenomenon after Levator Resection in Congenital Ptosis.

BACKGROUND

Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed recovery can result in vision threatening corneal complications.

AIM

To study the variability of Bell's phenomenon and time taken for its recovery following levator resection for blepharoptosis and to correlate it with the amount of resection.

METHODS

A prospective observational study was conducted on 32 eyes of 32 patients diagnosed as unilateral simple congenital blepharoptosis who underwent levator resection at a tertiary care center between July 2013 and May 2015. Patients were followed up for 5 months and correction of ptosis, type of Bells, duration of Bells recovery and complications were noted.

RESULTS

The study group ranged from 16-25 years with 15:17 male: female ratio. There were 9 mild, 16 moderate and 7 severe ptosis. Satisfactory correction was achieved in all cases. Good Bells recovery occurred in 13 eyes on first post-op day, in 2-14 days in 19 eyes and 28 days in 1 eye. Inverse Bells was noted along with lid oedema and ecchymosis in 2 patients. Large resections (23-26mm) were associated with poor Bells on the first postoperative day (p=0.027, Fishers exact test). However, the duration required for recovery of Bells phenomenon did not show any significant difference with the amount of resection. (p=0.248, Mann Whitney test). Larger resections resulted in greater lagophthalmos (correlation=0.830, p<0.0001). Patients with recovery of Bells delayed for more than 7 days were associated with greater number of complications (p=0.001 Fisher`s Exact Test).

CONCLUSION

Close monitoring for Bell`s recovery is required following levator resection.