Bilateral Facial Nerve Palsy Following Trauma: A Rare Case Report.

Bilateral facial paralysis occurs due to basilar skull fracture which involves temporal bone. It might be is rare. Unlike unilateral facial palsy, it can be difficult to recognize because of a lack of facial asymmetry. Proper clinical history and thorough physical exam are needed for a diagnosis. To confirm high-resolution computed tomography scan and electrodiagnostic tests should be done which will help to make the final diagnosis of bilateral facial nerve palsy. It will also help in the early detection of the case and intervention may be important for optimal functional recovery. We have reported a 28-year-old male who received a blow to the left side of his face due to road traffic accident.

Bell's Phenomenon during Screening Examination for Retinopathy of Prematurity

PURPOSE: Bell's phenomenon (BP), which may disturb screening examinations for retinopathy of prematurity (ROP), is known to present infrequently in premature babies. Stress associated with the examinations can influence expression of BP. The authors of the present study evaluated BP during examinations for ROP. METHODS: The present study included 102 eyes of 51 premature babies. Expression of BP was assessed at 3 steps of the examination in the following order: after insertion of a speculum, after illumination of an indirect ophthalmoscope and after scleral depression. The relationship between the expression of BP and the gestational age at the examination was analyzed in each step of the examination. RESULTS: The frequency of BP after the speculum insertion and the illumination was 77% to 92% in infants 32 weeks of age or younger, and decreased significantly to 16% to 57% in infants 42 weeks of age or older (p < 0.005). BP after the scleral depression had no significant association with the gestational age. Frequency of BP increased significantly as the steps of the examination proceeded (p < 0.01). CONCLUSIONS: BP was frequent in premature infants during ROP examination in spite of neurological immaturity. The examiner should take BP into consideration, which frequently occurs in younger infants.

Inverse Bell's Phenomenon Following Repeated Levator Resection Surgery

PURPOSE: We report a complication involving a transient inversion of Bell's phenomenon observed following extensive levator resection performed to treat aponeurotic ptosis. CASE SUMMARY: A 22 year old female patient complained of ptosis of both eyelid. The levator function of both lid was good, and a normal corneal protection mechanism was observed. The patient underwent levator resection and several reoperation because of asymmetrical lid height and entropion. Inversion of Bell's phenomenon was observed in the postoperative period. Eye with Bell's phenomenon reverted to normal within 1 month after final operation, and there were no corneal erosion. Lubricating eyedrop was used frequently during the postoperative period. CONCLUSIONS: It is important to consider that abnormal cases of Bell's phenomenon sometimes manifest after repetitive and extensive levator resection and to keep a close watch on the cornea while providing it with ample lubrication.

Frontalis Suspension Using a Silicone Rod in Blepharoptosis Patients with Poor Ocular Motility

PURPOSE: To determine the efficacy of frontalis sling operation with silicone rods in patients with compromised corneal protective mechanisms. METHODS: The authors retrospectively studied 6 consecutive patients (7 eyelids) with severe blepharoptosis with poor ocular motility who had undergone frontalis sling operations using silicone rods. RESULTS: Preoperative diagnoses included third nerve palsy in 4 patients, double elevator palsy in 1 patient, and suspicious oculopharyngeal muscular dystrophy in 1 patient. With a mean follow up of 27.7 months, a good final lid height was achieved in all 7 eyelids. Mild exposure keratopathy occurred postoperatively in 3 patients. During the follow-up period, no other significant complications, such as extrusion of the sling or infection, occurred. CONCLUSIONS: Silicone rods are effective and safe materials for use in frontalis suspension in treating blepharoptosis in patients with inadequate or absent Bell's phenomenon, resulting in poor eye protective mechanisms associated with an increased incidence of corneal exposure.

Bell's Phenomenon and Conjunctival Injury in Screening Examination for Retinopathy of Prematurity

PURPOSE: Bell's phenomenon (BP) was known not to be common in premature babies. If manifested, it may be detected on screening examinations for retinopathy of prematurity (ROP), indicating that conjunctival injury may have occurred. We studied correlations with BP and conjunctival injuries. METHODS: Ninety-two eyes of 46 premature babies, ranging from 36 to 38 weeks of gestational age, underwent screening examination for ROP. Rotation of the eyeball was evaluated with an inserted speculum. After observing temporal and nasal ora serrata with indentation, conjunctiva was examined for any possible damage. RESULTS: BP was observed in 50 of 92 subjects (54%). Notable conjunctival hemorrhage was found in 7 of 50 eyes (14%) with BP and in 2 of 42 eyes (5%) without BP. Stronger BP is correlated with severe injury to the conjunctiva (p<0.001). CONCLUSIONS: Bell's phenomenon (BP) may manifest in screening examinations for ROP. Manifestations of BP are related to conjunctival injury.