Case report: Inverse Bell’s phenomenon presents after frontalis sling surgery

Upward and outward movement of the eyeball on attempted voluntary lid closure is called Bell’s phenomenon, as named by Charles Bell. This is a common clinical finding in 75% of normal individuals. The significance of this is often felt in those eyes that have ptosis and require surgical correction.Preoperative Bell’s phenomenon is often examined in eyes before surgery as a part of the preliminary workup. Downward movement of the eye on closure is known as inverse Bell’s. This has been known to happen after levator resection surgeries, as reported by Betharia and colleagues, and there have been a few more reports substantiating the chance of inverse Bell’s after supramaximal levator resection following congenital ptosis. However, there are no previous reports or literature showing the risk of inverse Bell’s after sling surgery. We report a case of congenital ptosis in which normal Bell’s changed to inverse Bell’s following simple frontalis sling surgery.